On March 25, 2019, the Office of Inspector General (OIG) published its Medicaid Fraud Control Units Fiscal Year 2018 Annual Report. Forty-nine states and the District of Columbia have a Medicaid Fraud Control Unit (MFCU) which is responsible for investigating and prosecuting Medicaid provider fraud and patient neglect and abuse. The report notes that it “is a top OIG priority to strengthen the effectiveness of Medicaid Fraud Control Units”. The annual report includes statistical data on case outcomes, including convictions, civil settlements and judgements, and recoveries from all 50 MFCUs.
The below chart (taken from the OIG website) provides an overview of the statistical data for FY 2018. For FY 2018, MCFUs reported a total of 1503 convictions, 810 civil settlements, and $859 million in criminal and civil recoveries. The $545 million in civil recoveries reflects recoveries for Medicaid fraud only. In FY 2018, the Department of Justice recovered an additional $2.5 billion dollars in civil fraud and False Claims Act cases involving federal healthcare programs.
A breakdown of the MFCU case outcomes by provider and case type can be found within the report. The OIG also published an interactive map of outcomes by state.
