MFCU Frequently Asked Questions
Report Fraud and Abuse
How do I report suspected Medicaid provider fraud?
Call the Wyoming Attorney General's Medicaid Fraud Control Unit at 307-777-3444, or toll free 1-800-378-0345. You may also email complaints to email@example.com, or file a report online by clicking here. A printable copy of the form is also available here.
You can also report provider fraud to the Wyoming Department of Health, Division of Healthcare Financing, Program Integrity Unit at 307-777-7531 or toll free 1-855-746-2563, or file a report online by clicking here.
How do I report suspected abuse or neglect of a patient in a residential care facility?
In Wyoming, every citizen is a mandatory reporter if they know or have reasonable cause to believe that a vulnerable adult is being abused, neglected, exploited, intimidated, abandoned, or is committing self neglect. Reports must be made to law enforcement or to the Department of Family Services. Reports may be made in person, or by phone.
You can report vulnerable adult abuse by calling the Wyoming Attorney General's Medicaid Fraud Control Unit at 307-777-3444, or toll free 1-800-378-0345. You may also email complaints to firstname.lastname@example.org, or file a report online by clicking here.
You can also call the Wyoming Department of Family Services, Adult Protective Services, by calling 307-886-9232, or toll free in Wyoming 1-800-457-3659. You can find more information about Adult Protective Services by visiting the Department's website.
You may also report abuse or neglect to your local police or sheriff's departments.
In case of an emergency, call 911.
Medicaid Fraud Control Basics
What is Medicaid?
Medicaid is a state and federal partnership which provides medical benefits to children, pregnant women, families with children, and individuals who are aged, blind, or disabled in Wyoming. The federal and state governments have established eligibility criteria for the Wyoming Medicaid program. Eligibility is based on residency, income, and sometimes resources or healthcare needs. Individuals looking for more information about the Wyoming Medicaid program can find more information on the program's website.
What is the MFCU?
The Wyoming Medicaid Fraud Control Unit was founded in 1994 by Executive Order 1994-10. The MFCU is a division of the Wyoming Attorney General's Office, and is separate from the state Medicaid agency. The MFCU has statewide authority to investigate and criminally prosecute (or refer for prosecution) cases of Medicaid fraud, and patient abuse or neglect in residential care facilities. The MFCU may also bring civil actions to recover false Medicaid claims. The MFCU has a memorandum of understanding with Wyoming Medicaid, which describes the agencies' working relationship.
How does the MFCU get cases?
Whistleblowers, Medicaid recipients, Medicaid providers, and other Wyoming citizens are our most common source of referrals. The MFCU also receives referrals from state and local law enforcement agencies, the Wyoming Department of Health, Wyoming Department of Family Services, and the United States Department of Health and Human Services. We also find new cases while investigating other referrals.
What is Medicaid provider fraud?
Most health care providers are honest and provide quality services. Provider fraud still costs Medicaid millions of dollars. Medicaid fraud hurts taxpayers by diverting state funds from their intended purpose. Medicaid fraud hurts participants by limiting the funds available for their medical needs.
Medicaid fraud involves the knowing using a false statement, a misrepresentation, or the failure to disclose a material fact in providing medical assistance in the Medicaid program. Medicaid fraud is a felony if the value of the assistance is over $500, otherwise, it's a misdemeanor.
Does the MFCU handle concerns related to Medicaid benefits?
Does the MFCU investigate or prosecute Medicare fraud?
Medicare is a federally administered health insurance program for individuals age 65 or older, individuals receiving Social Security Disability Insurance, or individuals with End-State Renal Disease. The MFCU can only investigate Medicare fraud if the cases is primarily related to Medicaid and with the consent of the U.S. Department of Health and Human Services, Office of the Inspector General. You can report Medicare fraud by calling 1-800-MEDICARE (1-800-633-4227), 1-800-HHS-TIPS (1-800-447-8477), TTY 1-800-337-4950, or by visiting the Medicare.gov website.
What are some examples of common fraud schemes?
There is no single example of Medicaid fraud. Medicaid fraud can include some medical services, or no service at all. Typical fraud schemes include unnecessarily increased costs, the overuse of resources, or inaccurate payments. Here are some common schemes used by criminals who take money from the program:
Billing for medical good or services that were not provided;
Paying or accepting a “kickback” in exchange for a medical referral;
Concealing ownership in a related company;
Using false credentials;
Billing twice for the exact same service or item;
Billing Medicaid and the participant for the same service or item;
Billing a more expensive service than the one actually provided;
Prescribing or providing an unnecessary service; or
Forging patient records or service documentation.
How can I protect myself and the Medicaid program?
Medicaid participants can help prevent fraud by staying alert and protecting their information. Examples of ways that you can protect yourself include:
Regularly review your medical bills to ensure charges and dates are correct;
Ask for a copy of everything you sign;
Be suspicious of anyone offering tests in exchange for your Medicaid number;
Only share your Medicaid number, records, and other information with your medical providers;
Don’t consent to or ask for medical treatment that you don’t need; and
Don’t sign blank medical forms.
Most importantly: If you know of or suspect fraudulent activities, report it!
Abuse, Neglect, and Misappropriation of Funds
What is the MFCU's abuse and neglect jurisdiction?
The Medicaid Fraud Control Unit can review, investigate, and prosecute cases of abuse, neglect, and misappropriation of patient funds in Medicaid funded facilities such as nursing homes, hospitals, and group homes. The MFCU can also review, investigate, and prosecute cases of abuse, neglect, and misappropriation of funds of Medicaid participants in all other service settings.
What is abuse?
Abuse means intentional or reckless injury, unreasonable confinement, cruel punishment, sexual abuse, intimidation, or exploitation. Abuse can be caused by a caregiver, family member, persons of trust or authority, or a stranger.
What is neglect?
Neglect means taking or failing to provide a patient’s food, shelter, clothing, supervision, physical or mental health care, or medication needed to avoid physical or mental harm or illness.
What is misappropriation?
Misappropriation means temporarily or permanently exploiting, wrongfully using, or intentionally misplacing a resident’s property or money.
What is a Medicaid funded facility?
A Medicaid funded facility is any in-patient or residential setting where two or more unrelated persons live and receive nursing care or substantial assistance with their activities of daily living. The MFCU investigates abuse and neglect in Medicaid funded facilities regardless of the patient's Medicaid eligibility or payment source.
What are warnings signs of abuse, neglect, and misappropriation?
There is no single form of abuse, neglect, or misappropriation. Patients may suffer physical, emotional, or financial harm as a result of these crimes. Patients, family members, caregivers, and concerned citizens can be on the look out for these common signs:
Unexplained or unusual bruising, bleeding, wounds, or sores;
Other forms of physical injury such as bed sores, burns, cuts, or abrasions;
Sudden and unexplained changes in weight or appearance;
Sprained or broken bones;
Acting withdrawn or frightened;
Theft of personal items;
Dirty clothes, an unkempt appearance, or skin rashes;
The use of harassment, intimidation, or undue influence to gain property or money;
Taking photographs or video in places where patients have a reasonable expectation of privacy, such as a restroom, bath, shower, or dressing room;
Missing or broken dentures, glasses, hearing aids, walkers, or other personal items or aids;
Forcing, compelling, coercing, or enticing a resident to perform services against the resident’s will; or
Taking, selling, or throwing away a patient’s medications.
How can I protect myself or my loved one?
If you suspect a Medicaid or board-and-care provider of abuse, neglect, or misappropriation, REPORT IT to your local DFS office, law enforcement, and the Medicaid Fraud Control Unit.
The Medicaid Fraud Control Unit only investigates and prosecutes Medicaid recipient fraud if it is in conjunction with provider fraud. Otherwise, if you believe that a Medicaid participant obtained services by fraud, please contact the Wyoming Department of Health, Division of Healthcare Financing at 1-855-846-2563 or (307) 777-7531. You can also fill out their Wyoming Medicaid Fraud, Waste, & Abuse Confidential Complaint Form.
If you have questions about Medicaid benefits you can contact the Medicaid Customer Service Center at 1-855-294-2127, or visit the Wyoming Medicaid website.