State Medicaid Fraud Control Unit outlines prosecutions, national takedown participation

Charles Buka, director of the New Hampshire Medicaid Fraud Control Unit in the attorney general’s office, told the committee the unit investigates and prosecutes provider fraud, resident abuse and drug diversion and works closely with federal partners. "The Medicaid fraud control unit investigates and prosecutes fraud by health care providers who treat Medicaid beneficiaries within the state," Buka said, describing common schemes including billing for services not rendered, upcoding, drug substitution and kickbacks.

Buka outlined the unit’s staffing—three full-time prosecutors including the director, two investigators, a financial analyst, a paralegal and administrative support when fully staffed—and said 75% of the unit’s funding comes from a federal grant with the remainder from state funds. He highlighted cooperative work with the U.S. Attorney’s Office, OIG and FBI and noted the unit’s participation in the 2026 National Health Care Takedown. "This 2026 national health care takedown… involved 455 defendants across 56 federal districts and 45 states and territories," he said, adding New Hampshire contributed cases and received federal investigative assistance for voluminous digital evidence.

Buka described the process for referrals: the DHHS program-integrity unit and MCO special-investigations units feed potential cases to the MFCU; the unit reviews, accepts or declines matters based on federal funding requirements and jurisdiction, and may open civil or criminal actions. He said the office also prosecutes resident abuse and neglect when facilities are Medicaid-funded and will refer matters outside its jurisdiction to county attorneys or federal partners.