The Medicaid Fraud Control Unit (MFCU) focuses on cases involving fraud and patient abuse. The MFCU was created in 1984 with a staff of 12 and has grown to more than three dozen TBI employees across the state managed by one Special Agent in Charge and three Assistant Special Agents in Charge. Approximately 75 percent of this unit is federally funded.
Special Agents within MFCU investigate patient abuse and receive hundreds of referrals annually from various agencies in the healthcare field. The information obtained through these investigations is used to compile the state’s abuse registry, managed by the Tennessee Department of Health. The MFCU also opens dozens of fraud cases each year focusing on healthcare providers who obtain improper payments for services rendered, or supposedly rendered, to TennCare recipients. Since 1990, the MFCU has consistently identified more fraud dollars than the unit has spent. It is aggressive in assisting TennCare recover millions of dollars in restitution for Tennesseans each year.
The MFCU is the lead state agency acquiring global settlements which are the resolution of cases that often originate in other states, and are based on allegations that often are not yet the subject of investigation in Tennessee. Representatives of the MFCU are an integral part of the Nursing Home Abuse and Neglect Working Group, designed to create a better referral system and promote information sharing.