Medicaid fraud unit secures millions in recoveries

Wednesday, September 14, 2016

WASHINGTON – Medicaid Fraud Control Units in 2015 obtained 1,553 criminal convictions and 731 civil settlements and judgments for provider fraud and patient abuse and neglect, according to a new report from the Office of Inspector General.

Criminal recoveries were nearly $350 million, while civil recoveries reached nearly $395 million, the report states. Of those numbers, DMEPOS providers accounted for 33 criminal convictions with $12.7 million in recoveries; and 30 civil settlements and judgments with nearly $4.3 million in recoveries.

Overall, fraud cases accounted for 71% of convictions, with almost half of those involving unlicensed providers, including personal care attendants and homecare aids.

The number of civil settlements and judgments decreased from 908 in fiscal year 2011 to 731 in fiscal year 2015, according to the report.