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NAAGazette

NAMFCU?s Offers Specialized Training for MFCU Staff

Barbara L. Zelner, Counsel, National Association of Medicaid Fraud Control Units (NAMFCU)

Barbara L. Zelner, Counsel, National Association of Medicaid Fraud Control Units (NAMFCU)

One of the founding goals of the National Association of Medicaid Fraud Control Units (NAMFCU) is to improve the quality of Medicaid provider fraud investigations and prosecutions by offering employees specialized training. NAMFCU training programs provide state MFCU staff with the tools needed to build successful cases, and provide a venue for sharing investigative strategies with colleagues from around the country. In-service training greatly aids the success of the MFCUs.

Congress recognized the critical importance of training when it created the Medicaid Fraud Control program in 1977. The Senate Finance Committee Report that accompanied the federal legislation specifically identified the need for MFCUs to employ

attorneys, investigators and auditors that are specially trained to investigate and prosecute Medicaid provider fraud. The Report concluded that the only effective way to combat complex provider fraud schemes is to employ professionals within MFCUs that are sufficiently skilled to detect and successfully prosecute fraudulent activities. As a result, the founding legislation provides that the 75 percent federal reimbursement made available to subsidize MFCU operating expenses includes coverage for the training of MFCU personnel.

The Office of Inspector General (OIG), which is the agency vested with responsibility for overseeing the MFCU federal grant program, has formally endorsed the need for MFCUs to have in-service specialized training relating to investigating and prosecuting Medicaid fraud and resident abuse. More than a decade ago, OIG and NAMFCU jointly developed 12 performance standards that OIG currently uses during periodic on-site reviews to judge the effectiveness of MFCUs. One of the performance standards focuses on training. It establishes an expectation that each MFCU will have an annual training plan to address staff needs and sufficient funds to carry out the plan. The standard also sets forth an expectation that staff will have access to a reasonable level of training hours and will be afforded an opportunity to satisfy locally established continuing education requirements through fraud and abuse-related training.

Just this year, OIG issued a letter to MFCU Directors stressing the importance of training under the performance standards. OIG declared in its correspondence that satisfying the training performance standard was essential to ensuring that MFCUs are highly effective in investigating and prosecuting Medicaid provider fraud. OIG reiterated in its letter that MFCU costs associated with staff training, including travel and lodging, qualify for 75 percent federal reimbursement under the MFCU grant program.

For many years, NAMFCU has offered high quality professional training for MFCUs. Programs have focused on fraud in a wide range of provider settings including hospitals, nursing homes, laboratories, and physician practices. Programs have also covered a wide range of topics, such as recognizing fraudulent “kickbacks,” conducting undercover operations, effective interview techniques and selecting appropriate prosecution theories in provider fraud cases. NAMFCU’s training programs bring together all MFCU disciplines (prosecutors, investigators, auditors and data analysts) to learn about emerging legal issues and the most effective investigative techniques. This specialized Medicaid fraud training cannot be found anywhere else.

The importance of MFCU training is reflected in the resources that NAMFCU devotes to this discipline. The Association maintains a standing Training Committee that is co-chaired by an attorney and an investigator and has more than 20 active participants from MFCUs throughout the country. The Training Committee meets several times during the year to prepare training agendas. Specifically, the Training Committee is responsible for the following programs: (1) Introduction to Medicaid Fraud; (2) Practical Skills for Investigating and Prosecuting Medicaid Fraud Cases; (3) The Directors Symposium; and (4) the NAMFCU Annual Training Program.

The Introduction to Medicaid Fraud training program is conducted over three days. The sessions include an overview of the MFCU program and orient students to the policies and regulations that govern MFCUs. The course also provides instruction on provider fraud schemes, fraud in the administration of the program, resident abuse investigative techniques and fraud in institutional settings. The experienced MFCU faculty includes veteran attorneys, law enforcement and nurse investigators, auditors and computer analysts. NAMFCU offers this introductory course two to three times per year.

The Practical Skills course is also conducted over three days. This program focuses on four provider fraud subject areas. The teaching format utilizes small break-out sessions in order to foster a team approach to solving investigative and prosecution challenges. The program is geared toward more experienced MFCU employees and is premised on a low student to instructor ratio. The entire program is limited to 40 students. The four provider fraud subject areas that were featured at the most recent course included medical transportation, dentists, nursing home cost reports and pharmacies. NAMFCU anticipates featuring two Practical Skills training programs during 2008 to satisfy the current waiting list.

The annual Directors Symposium is held each year in Washington, D.C. and provides the Association’s 50 MFCU Directors with an opportunity to discuss the latest state and national provider fraud and resident abuse issues. The meeting also allows the Directors to conduct NAMFCU business relating to multi-state cases and to communicate directly with the OIG officials that are responsible for MFCU grant oversight.

The NAMFCU Annual Training Program, mostly recently hosted by the Georgia MFCU, provides an opportunity for MFCU employees in all disciplines to receive in-service training on the latest national trends relating to Medicaid provider fraud and resident abuse investigations and prosecutions.

In addition to organizing its own training opportunities, NAMFCU has for several years co-sponsored two educational programs with the American Bar Association (ABA): (1) The National Health Care Fraud Institute; and (2) The Civil False Claims And Qui Tam Enforcement Program. Additionally, the Association has co-sponsored an Elder Abuse Conference with the California MFCU, which has been held every other year. The ABA programs bring state and federal prosecutors, health care attorneys, criminal defense attorneys and counsel for federal and state False Claims Act (FCA) “whistleblowers” together to share experiences and concerns in a non-adversarial setting. The California conference has attracted more than 500 attendees from federal, state and local governments by offering comprehensive instruction on a wide variety of elder abuse subjects.

NAMFCU has a proud 30-year history of providing training to thousands of MFCU attorneys, investigators and auditors throughout the country. The Association looks forward to the challenge of continually developing successful programs that meet the needs of MFCU professionals so that they are best equipped to vigorously investigate and prosecute Medicaid provider fraud and resident abuse.

The National Association of Medicaid Fraud Control Units (NAMFCU) was founded in 1978 to provide the state MFCUs with a forum to facilitate communication. Today, the 50 MFCUs that comprise the Association are staffed by almost 2,000 attorneys, auditors, investigators and support staff. Most of these employees work for their state Attorney General. Forty-three of the MFCUs are housed in the office of the state Attorney General. For the other seven states (Connecticut, the District of Columbia, Georgia, Illinois, Iowa, Tennessee and West Virginia), the MFCU operates from a separate state agency, but even in those jurisdictions, the MFCU works with staff in the Attorney General’s office.

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