For Medicaid behavioral health providers, compliance officers, and the managed care and community partners who work alongside them, a payment suspension can end operations long before any finding of wrongdoing.
Billing scrutiny keeps intensifying, and an unprepared compliance program carries real financial consequences.
In “D.C. MFCU Ramps Up New Unit Focused on Fraud in Behavioral Health: Are Providers Ready?”, published by the American Health Law Association in Health Law Weekly, Sarah M. Hall, Member of the Firm of Epstein Becker Green and counsel to health care companies and individuals in government investigations and prosecutions, and Chloe T. Hillard, Associate of Epstein Becker Green who advises providers on government investigations and fraud, waste, and abuse compliance, examine how District of Columbia enforcement is reshaping risk for behavioral health providers. Clifford E. Barnes of Clifford E. Barnes, Esq. & Associates co-authored the piece, and Epstein Becker Green Staff Attorney Ann W. Parks contributed to its preparation.
The authors tie D.C.’s focus on behavioral health billing to a broader federal push on state Medicaid Fraud Control Units (MFCUs), including HHS-OIG’s 2026 actions against the Hawaii and New York units, and note that D.C.’s unit faces recertification in February 2027. They explain that the D.C. Department of Health Care Finance can suspend Medicaid payments on a “credible allegation of fraud,” a low threshold, and that suspensions usually last as long as the MFCU investigation, often years. For providers that depend on Medicaid, closure can come well before the merits are reached.
The authors recommend regular risk assessments, self-audits with documented follow-up, a designated compliance lead, a compliance committee, and close attention to unusual billing patterns over time. Providers, the authors wrote, “should take heed and use this time to pressure test their compliance program.”
Attorney Clifford E. Barnes of Clifford E. Barnes, Esq. & Associates, LLC contributed to this article.
Epstein Becker Green Staff Attorney Ann W. Parks contributed to the preparation of this article.
Get in Touch
To discuss how your organization can prepare for payment suspension and investigation risk in D.C. Medicaid, contact Sarah Hall at smhall@ebglaw.com or Chloe Hillard at chillard@ebglaw.com.
