Which entity is responsible for investigating provider fraud and reviewing complaints of resident abuse in nursing homes?

Which entity is responsible for investigating provider fraud and reviewing complaints of resident abuse in nursing homes?

• A. National Medical Audit Office
• B. Medicaid Fraud Control Unit
• C. Medicare Compliance Division
• D. State Health Integrity Office

Answer: (B)

The Medicaid Fraud Control Unit is the entity tasked with this dual role. These units, housed in state attorney general offices, specifically investigate fraud within Medicaid and review and respond to complaints of resident abuse or neglect in nursing homes and other facilities that participate in Medicaid. They have authority to examine billing and provider practices that misuse Medicaid funds and to pursue criminal or civil actions when abuse or exploitation of residents is found. This combination of Medicaid fraud investigation and resident abuse oversight is what makes the MF CU the correct choice. The other options do not represent a single agency with both responsibilities.

The Medicaid Fraud Control Unit is the entity tasked with this dual role. These units, housed in state attorney general offices, specifically investigate fraud within Medicaid and review and respond to complaints of resident abuse or neglect in nursing homes and other facilities that participate in Medicaid. They have authority to examine billing and provider practices that misuse Medicaid funds and to pursue criminal or civil actions when abuse or exploitation of residents is found. This combination of Medicaid fraud investigation and resident abuse oversight is what makes the MF CU the correct choice. The other options do not represent a single agency with both responsibilities.