PO BOX 56

JACKSON, MS 39205

WATTS: 1-800-852-8341

EMAIL: MFCU@AGO.STATE.MS.US

WEBSITE: WWW.AGJIMHOOD.COM

M E D I C A I D F R A U D C O N T R O L U N I T

The Mississippi Medicaid Fraud Control Unit (“Unit” or “MFCU”) is an entity of state government, annu-ally certifi ed by the Secretary of the U.S. Depart-ment of Health and Human Services. The MFCU conducts a statewide program for the investigation and prosecution of health care providers who de-fraud the Medicaid program. In addition, the MFCU reviews complaints of abuse or neglect against patients in health care facilities and may review complaints of the theft of patients’ private funds in these facilities. The Unit is also charged with in-vestigating fraud in the administration of the pro-gram.

The MFCU is a fully comprehensive law enforce-ment agency staffed by attorneys, investigators, an-alysts, auditors, nurses and support staff trained in the complex subject of health care fraud.

The Unit is funded by a federal grant which reim-burses 75% of the Unit’s expenditures. The remain-ing 25% is matched by the State of Mississippi.

M A N D A T O R YR E P O R T I N G

Any person employed by a care facility •

Who has knowledge of or reasonable cause • to believe that any patient or resident of a care facility has been the victim of abuse, neglect or exploitation

Shall report IMMEDIATELY the abuse, • neglect or exploitation.

Employees of home health agency shall • report within 24 hours to the MFCU and to the Department of Human Services.

Employees of all other care facilities • must report within 24 hours to the State Department of Health and the MFCU.

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MEDICAID FRAUD CONTROL UNIT

1-800-852-8341

MS DEPARTMENT OF HUMAN SERVICES

MS STATE DEPARTMENT OF HEALTH

1-800-222-8000

Prosecuting Medicaid Provider Fraud and Abuse, Neglect & Exploitation

OFFICE OF THE ATTORNEY GENERALSTATE OF MISSISSIPPI

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The Medicaid Program in Mississippi has thousands of enrolled providers who are rendering necessary and legitimate services. Only a small percentage of the total providers enrolled in the program are in-volved in fraudulent activity, and it is this segment of the provider community toward which the efforts of the Medicaid Fraud Control Unit are directed.

If you suspect that fraudulent activity involving Med-icaid providers is happening or patient abuse is oc-curring within a care facility, call our offi ce at 1-800-852-8341 or report online at www.agjimhood.com.

“As Attorney General, my pledge to the citizens of Mississippi is that I will provide sound legal ad-

vice, work to protect children and the elderly, strictly enforce our consumer protection laws, target illegal drugs in our communities, advo-cate for the rights of victims, promote school safety, and help prevent crime through preven-tion/intervention programs.”

P A T I E N T A B U S E , N E G L E C T & E X P L O I T A T I O N

“ABUSE”• means the willful or non-accidental infl iction of physical pain, injury or mental an-guish on a vulnerable person, the unreason-able confi nement of a vulnerable person, or the willful deprivation by a caretaker of servic-es which are necessary to maintain the men-tal and physical health of a vulnerable person. Abuse includes sexual abuse.

“NEGLECT”• means either the inability of a vul-nerable person who is living alone to provide for himself the food, clothing, shelter, health care or other services which are necessary to maintain his mental and physical health, or failure of a caretaker to supply the vulnerable person with the food, clothing, shelter, health care, supervision or other services which a reasonably prudent person would do to main-tain the vulnerable person’s mental and phys-ical health.

“EXPLOITATION”• means the illegal or improper use of a vulnerable person or his/her resourc-es for another’s profi t or advantage, with or without the consent of the vulnerable person, and includes acts committed pursuant to a power of attorney.

HOW CAN I HELP? EXAMPLES OF MEDICAID FRAUD:

“BILLING FOR SERVICES NOT PERFORMED”• A common type of Medicaid fraud committed by medical providers is the billing for services which are not provided to a recipient. This includes bill-ing for medical procedures, medical equipment and supplies, home health care, and transpor-tation to and from clinics or doctor’s offi ces which are not actually performed or provided.

“BILLING FOR MEDICALLY UNNECESSARY SERVICES”• A pro-vider misrepresents the diagnosis and symp-toms on recipient records and billing invoices to obtain payment for unnecessary services.

“RECRUITNG MEDICAID PATIENTS” • A recruiter offers cash or anything of value to a Medicaid recipi-ent to entice him/her to undergo medical tests or other services with the intent of billing Med-icaid for those services.

“DOUBLE BILLING”• A provider bills both Medicaid and a private insurance carrier (or the recipient) for the same medical service or procedure.

Activities of this nature may be violations of vari-ous federal and state criminal laws. In addition to the criminal penalties, those persons con-victed of Medicaid Fraud may lose their status as Medicaid Providers and in some cases their professional licenses as well.

REPORT PATIENT ABUSE, NEGLECT & EXPLOITATION.

REPORT MEDICAID FRAUD.