Key points
Federal fraud and abuse laws apply to awardee VFC Programs. State regulations (e.g., related to insurance, consumer protection, or medical licensure) may likewise be appropriate for parts of awardee VFC Programs involving state funds.
Defining fraud and abuse
Federal fraud and abuse laws apply to awardee VFC Programs. State regulations (e.g., related to insurance, consumer protection, or medical licensure) may likewise be appropriate for parts of awardee VFC Programs involving state funds.
The terms "fraud" and "abuse" used by the VFC Program are consistent with the definitions for fraud and abuse in Medicaid regulations.
- Fraud
- An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself/herself or some other person.
- It includes any act that constitutes fraud under applicable federal or state laws.
- An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself/herself or some other person.
- Abuse
- Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program (and/or including actions that result in an unnecessary cost to the immunization program, a health insurance company, or a patient), or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.
- Abuse also includes recipient practices that result in unnecessary cost to the Medicaid program.
- Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program (and/or including actions that result in an unnecessary cost to the immunization program, a health insurance company, or a patient), or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.
Reporting fraud and abuse in the PEAR system
All fraud and abuse allegations/cases must be documented and tracked within the PEAR system.
Preventing fraud and abuse
Efficient and accurately managed VFC Program accountability programs are the foundation for preventing fraud and abuse incidents. Communication with providers can support and assist with preventing situations that may develop into fraud and abuse.
Awardee VFC Program policies and systems must have well-defined processes for addressing the prevention, detection, investigation, and resolution of VFC Program claims, as well as federal requirements regarding reporting of suspected fraud and abuse.
More information
VFC Program Vaccine Storage and Handling Resources
CDC has developed resources that describe proper vaccine storage and handling procedures. Please refer to these resources for storage and handling procedures of VFC Program vaccines: