Investigations & Terminations

Investigations

MMAC investigators are responsible for conducting investigations into allegations of fraud, waste and abuse by providers and participants. Investigators conduct interviews with witnesses as well as those suspected of violating state regulation, state statute and federal regulations.

In the event the investigation reveals a credible allegation of fraud by a provider, MMAC will forward the information to the Medicaid Fraud Control Unit (MFCU), or other prosecutorial entity for review.

If the investigation reveals probable cause of fraud by a participant, MMAC will forward the information to the Division of Legal Services Unit for review.

Terminations

The Terminations staff is responsible for terminating providers from the Medicaid program and working with the Centers for Medicare and Medicaid Services to ensure appropriate notification is made when a provider is terminated.