The Colorado Medicaid Fraud Control Unit’s (MFCU) mission is to protect state and federal funds from fraud against Medicaid by individuals or companies who provide services; and to protect residents of long-term care facilities from physical abuse or neglect.
The MFCU employs a professional staff of criminal investigators, an auditor, a nurse investigator, and prosecutors experienced in criminal and civil investigations.
The MFCU’s abuse jurisdiction to prosecute physical abuse or neglect extends to all personal care boarding homes, adult day care facilities, hospitals, skilled nursing centers, rehabilitation centers, long-term facilities, and some assisted living centers – regardless of whether the resident is a Medicaid recipient or not. The Unit does not investigate abuse in the home or in non-Medicaid facilities. Our fraud jurisdiction covers all Medicaid providers.
The MFCU has authority to hold individuals or entities accountable through criminal prosecution and/or civil litigation. The Unit also makes recommendations to the U.S. Department of Health and Human Services, Office of the Inspector General to exclude individuals or entities from participating in Federally-funded programs.
If you are a victim of fraud, abuse, or neglect by a Medicaid provider, or if you know of or suspect an at-risk person is a victim of these crimes, you should contact your local law enforcement agency or the Medicaid Fraud Control Unit.
Fraud against Medicaid by recipients is investigated by each county through the local office of the Colorado Department of Human Services.
Receiving Medicaid services is critical for many Coloradans, and our goal is to effectively investigate, prosecute, and recover overpayments for the State Medicaid Program; and to ensure the safety of long-term care patients in Medicaid funded facilities.
The MFCU is a member of:
- National Association of Medicaid Fraud Control Units - www.namfcu.net
- Joint Health Care Fraud Task Force
- Special Investigations Unit Working Group