After receiving a hefty check in settlement of a False Claims Act case, one of our client relators presented us with a mug saying “G-D Bless NAMFCU.” He wanted to recognize the vital role that NAMFCU played in the investigation, prosecution and settlement of his case. But most relators, especially at the outset of their case, do not know anything about NAMFCU (pronounced Nam-Foo-Koo), or how that organization plays a vital role in assisting relators pursue Medicaid fraud claims brought through a qui tam case.
NAMFCU is the National Association of Medicaid Fraud Control Units. It is comprised of representatives from each state’s Medicaid Fraud Control Unit throughout the nation, and was established in 1977. A state Medicaid Fraud Control Unit or MFCU (pronounced Mih-Foo-Koo or Mif-Que) is typically a division of a state attorney general’s office comprised of prosecutors, auditors and investigators dedicated to investigating and prosecuting fraud against the Medicaid program. Six states have MFCUs that are not part of their attorney general’s office (Connecticut, District of Columbia, Illinois, Iowa, Tennessee, and West Virginia). There are 50 MFCU’s in NAMFCU, including the District of Columbia (but excluding North Dakota, which has received a federal waiver from participating in the program).
Medicaid, which provides health care funding for low-income families or individuals, is administered by each state, but funded jointly by state and federal governments. Accordingly, MFCUs are jointly funded by state and federal governments. Typically, 75% of MFCU funding is provided by the federal government, with the remainder provided by the state.
Many qui tam cases involve fraud against the Medicaid programs, including some of the largest cases ever that settled for billions and hundreds of millions of dollars. NAMCU has played a critical role in these cases, by providing essential resources for investigation and prosecution.
NAMFCU has a process for carefully reviewing every qui tam case alleging multi-state Medicaid fraud. This review is handled by NAMFCU’s qui tam subcommittee. This subcommittee is staffed by a representative from each state with a False Claims Act that has a qui tam provision allowing private citizens to file the case as a relator. The qui tam subcommittee is co-chaired by Jay Speers of the New York MFCU and Christen Nedwick of the Texas MFCU.
When a relator files a False Claims Act complaint alleging multi-state Medicaid fraud, the NAMFCU qui tam subcommittee assigns members to an intake team to assess the strength of the case and investigative steps needed to evaluate the relator’s allegations. This can involve reviewing state Medicaid data to determine whether internal data corroborates the relator’s allegations.
The intake team reports its assessment to the full NAMFCU qui tam subcommittee. Based on the strength of the case and other factors, such as patient safety and the amount of damages, the subcommittee determines whether a NAMFCU investigative team will be assigned to the case.
As our client expressed through his “G-d bless NAMFCU” mug, the involvement of NAMFCU and its investigative and prosecutorial resources can make a critical contribution to the success of a Medicaid fraud qui tam action. The attorneys at Behn & Wyetzner have over a decade of experience working with NAMFCU and multiple state MFCUs to successfully pursue their clients claims. Michael Behn has taught other attorneys how to work with state prosecutors and investigators at numerous national bar meetings, including those sponsored by the U.S. Department of Justice, the U.S. Department of Health and Human Services, NAMFCU, the American Bar Association and various states and state bar associations. Contact us if you believe we can assist you with a potential qui tam case involving health care fraud.