The National Association of Medicaid Fraud Control Units (NAMFCU) is an organization of officials from those state agencies which is responsible for investigating Medicaid Fraud. NAMFCU helps coordinate national investigations and prosecution of Medicaid Fraud for the states. NAMFCU facilitates joint discussions of cases involving fraud where more than one state’s Medicaid system has been impacted.
If the Government does not intervene in a case, the Relator and her counsel are generally free to pursue the case without the Government’s help. However, cases filed under the New York City False Claims Act cannot proceed without the permission of the Corporation Counsel. Likewise, the IRS whistleblower statute does not provide whistleblowers who initiate actions under the statute with any right to pursue a case if the Government decides not to do so.
The United States Department of Justice (DOJ) attorneys represent Federal Agencies that have been defrauded. Under state false claims acts, the respective State Attorneys General represent the interests of each state and each state agency.
Federal Agencies, such as the Food and Drug Administration, the Department of Energy, etc., are the clients of DOJ. Frequently, if the agency does not believe that fraud has been committed or that the agency has not been wronged, the DOJ will not “intervene” in a False Claims Act case.
Federal Agencies have offices of “Inspector General” who are charged with investigating fraud and abuse. In many cases, representatives of the applicable agency’s Inspector General office will work closely with DOJ. The agency also will have a General Counsel’s office, which will play a role in deciding whether to intervene and/or litigate the case.