CASE Study

MFCU Achieves Scalability

Since 1978, federally funded Medicaid Fraud Control Units (MFCUs) have been at the forefront of maintaining the integrity of the Medicaid program.

While approximately $1.9 billion of taxpayers’ money was recovered by MFCU’s in 2019 from fraud activities like Double Billing, Phantom Billing and False Cost Reports, the high caseload overwhelms most state MFCU agencies. Agents are overworked and forced to prioritize only the worst cases, leaving the rest unprosecuted.

A Valid8 MFCU customer had limited budget availability for increased headcount and the escalating workload threatened to overwhelm their resources.

Recognizing that huge amounts of time and resources were being expended on sorting, reviewing, transcribing and transfer matching bank statement transactions, they reached out to Valid8 for help following a recommendation from a neighboring MFCU.

Process

Following a successful Pilot completion, budget was secured for the upcoming fiscal year and training was delivered in one hour to over 90 team members.
Valid8 extracted the data from the statements and reconciled against the amounts extracted from the checks, alongside Payee and Payor details.
The MFCU team was able to deliver consistent, standardized transaction-level data sets to simplify discovery by state prosecutors.

Outcome

Check images were automatically reconciled against bank statement entries, addressing a significant data reconciliation gap that had existed to date.
In the first three months, the MFCU was able to recognize a 60% faster review of financial records, all with the existing team size.
In the first 18 months, over 1 million transactions were reconciled from 100,000 pages, covering hundreds of cases.

Customer Testimonials

“The granularity that Valid8 brings to check details plugs a long-standing gap in the completeness of financial investigations.”

“The automation Valid8 delivered boosted team morale and empowered the investigators to push forward with vigor.”

“The details of checks hold the information required, but teams can't scale to accomplish the necessary reviews.”

Need to prepare evidence? Help your team follow the flow of funds faster.

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