State Medicaid Fraud Control Units
Medicaid Fraud Program
CSFA Number: 493-60-0325
STATE AGENCY INFORMATION
Agency Name
Illinois State Police (493)
Agency Identification
Illinois State Police Medicaid Fraud Control Burea
Agency Contact
PROGRAM INFORMATION
Short Description
Provides funds to ISP for investigative services for providers of medical services suspected of fraud or other criminal acts perpetrated wtihin Public Assistance Programs administered by IDHS.
Federal Authorization
Social Security Act
Illinois Statue Authorization
Department of State Police Act
Illinois Administrative Rules Authorization
Social Security Act
Objective
To eliminate fraud and patient abuse in the State Medicaid Programs.
UGA Program Terms
Comply with grant award terms and special conditions.
Eligible Applicants
Government Organizations;
Applicant Eligibility
An established State Medicaid Fraud Control Unit must be a single identifiable entity of the State government which the Secretary certifies (and the Office of Inspector General annually re-certifies) as complying with the requirements of 1903(q) of the Social Security Act (42 CFR 1007) regarding location, function and procedure. Applicants must also comply with section 1902 (a)(61) of the Act as amended by the Omnibus Budget Reconciliation Act of 1993. Tribes (American Indian/Alaskan Native/Native American) are not eligible to apply.
Beneficiary Eligibility
Grantees are State entities.
Types of Assistance
Formula Grants
Subject / Service Area
Public Safety
Credentials / Documentation
Units must submit applications containing proposed organization, administration, agreements, detailed budgets and procedures for certification of eligibility (see 42 CFR 1007). Costs will be determined in accordance with 2 CFR 200 and 45 CFR 75. Governors in States applying for Federal assistance must approve the application pursuant to 42 CFR 1007.15(a)
Preapplication Coordination
Environmental Impact Reports
Application Procedures
The standard application forms (SF 424 and SF 424A) must be used for the application. The Inspector General's staff is available to assist with technical development of programs, plans, and budget amendments and revisions."}
Criteria Selecting Proposals
N/A
Award Procedures
States are awarded funds based on a detailed description of estimated expenditures needed to support the program. Award funds are distributed quarterly on a fiscal year basis as follows: October 1, January 1, April 1, and July 1.
Range of Approval or Disapproval Time
30-90 days
Appeals
If the application is not approved, the State may submit an amended application at any time.
Renewals
The application for the annual re-certification must be submitted 60 days prior to the end of each certification period.
Uses and Restrictions
This is only available for ISP use.
Reports
Annual Reports are required and must be submitted 60 days prior to the expiration of the MFCU's certification period. Federal Cash Transaction Reports (FCTR) to report cash transactions are required on a quarterly basis to PMS. An Annual Report to report the MFCUs statistics is required. Expenditure reports on the SF-425 are required to be submitted in PMS and are due 30 days following each quarter and a final expenditure report is required and is due 90 days after the grant period end date. Performance monitoring is required through the submission of annual reports by the MFCUs to HHS/OIG and through site visits to the MFCUs that are conducted by the HHS/OIG
Audits
OIG performs periodic onsite reviews of the State program, as appropriate, as well as an annual re-certification review of each SMFCU.
Records
All records are to be retained for 3 years, in accordance with 45 CFR 75.361.
Account Identification
75-0512-0-1-551;
Obligations
(Formula Grants) FY 20$290,000,000.00; FY 21 est $299,000,000.00; FY 22 est $308,000,000.00; FY 19$280,800,000.00; FY 18$270,000,000.00; -
Range and Average of Financial Assistance
FY 2021: Range $344,536 to $41,264,032; Average $5,408,956
Program Accomplishments
The unit reports annual statistics summarizing the current caseload being worked by the unit as well as successful dispositions of cases worked by the unit. These stats are compiled into reports by Health and Human Services-Office of Inspector General that can be viewed at the following link:
https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/
Regulations, Guidelines, and Literature
42 CFR 1007, 45 CFR 75, and Performance Standards originally issued September 1994 and revised in June 2012.
Regional or Local Assistance Location
N/A
Headquarters Office
330 Independence Ave SW, Cohen Bldg Ste 1062, DC
Program Website
http://www.oig.hhs.gov
Example Projects
Payroll and benefits for MFCB employees, covert vehicle purchases, computer equipment purchases, fuel and maintenance for MFCB vehicles, telecommunications expenses, travel expenses related to the program, training expenses related to the program, and a multitude of other operational necessities
FUNDING INFORMATION
Funding By Fiscal Year
FY 2015 : $5,716,012
FY 2016 : $5,572,711
FY 2017 : $12,602,000
FY 2018 : $10,396,732
FY 2019 : $10,790,228
FY 2020 : $11,329,739
FY 2021 : $11,896,229
FY 2022 : $11,500,510
Federal Funding
Notice of Funding Opportunities
| Agency ID | Award Range | Application Range |
ACTIVE AWARDS