Medicaid Fraud Control Units Recovered Nearly $1.9 Billion in 2016

On May 19, 2017, the Department of Health & Human Services, Office of the Inspector General (OIG), published the Fiscal Year 2016 Report on Medicaid Fraud Control Units (MFCUs), which investigate and prosecute Medicaid provider fraud and patient abuse or neglect.

The MFCUs reported criminal and civil recoveries of nearly $1.9 billion in 2016. The MFCUs spent $259 million in state and federal funds. Therefore, on average, the MFCUs recovered over seven dollars for each dollar spent.

MFCU investigations in 2016 also resulted in 1,564 convictions. Fraud cases accounted for 74% of the convictions and 35% of the convictions involved personal care services, such as home care aides and agency representatives. In one case, a home health aide was fined and sentenced to two years in prison for falsifying timesheets.

New Jersey reported 379 open fraud investigations, 21 fraud convictions and 13 civil settlements for 2016. The total recovery in this state was over $47.3 million.

The full report can be found on OIG’s website: https://oig.hhs.gov/ oei/reports/oei-09-17-00210.pdf