Criminal Justice Division

The Medicaid Fraud Control Unit (MFCU) investigates and prosecutes provider fraud involving medical assistance programs, as well as patient abuse and neglect statewide. The unit is 75% federally funded, and is staffed by three attorneys, three auditors, seven investigators, and three clerical staffers.

MFCU’s jurisdiction over Medicaid Fraud consists largely of provider theft of Medicaid funds through deceptive claims made with the state Medicaid program. Some types of deceptive claims are:

• Claims for services not rendered
• Multiple claims for a single service or supply
• Billing at a higher rate than permitted for the service or supply provided

MFCU’s jurisdiction over abuse consists largely of physical violence, neglect, and financial exploitation of dependent adults committed by Medicaid providers, care facilities, and paid caregivers. MFCU is authorized to proceed criminally and/or civilly.

MFCU’s jurisdiction over civil false Medicaid claims consists largely of unlawful provider activity that results in inappropriate claims from the Medicaid program.

Who is eligible for Medicaid benefits? MFCU does not address eligibility issues. The following links may be helpful:

• Hawaii Department of Human Services (https://hawaii.gov/dhs)
• Centers for Medicare and Medicaid Services (https://www.cms.hhs.gov)
• Legal Aid Society of Hawaii (https://www.legalaidhawaii.org/services.html)

How do I report abuse or fraud? It depends on the subject of the allegation.

• If the allegation involves a Medicaid provider, care facility, or paid caregiver, you may contact MFCU at (808) 586-1058, or the Department of Human Services Adult Protective Services office (https://www.hawaii.gov/dhs/Adult%20Protective%20Services.pdf)
• If the allegation involves a family member, you may call the police or contact Adult Protective Services (https://www.hawaii.gov/dhs/Adult%20Protective%20Services.pdf).
• If the allegation involves beneficiary fraud, you may contact the Department of the Attorney General Criminal Justice Division at 586-1160, or the Department of Human Services (https://hawaii.gov/dhs).