Medicaid fraud units secure thousands of convictions

Tuesday, March 11, 2014

WASHINGTON – Nationwide, Medicaid Fraud Control Units (MFCU) in 2013 secured 1,341 criminal convictions and 879 civil settlements and judgments in cases involving Medicaid fraud and patient abuse and neglect, according to a report from the Office of Inspector General (OIG).

Criminal recoveries reached nearly $1 billion, while civil recoveries topped $1.5 billion, the March 7 report says. Both types of cases involved a variety of providers, but the most notable were home health agencies in criminal court and pharmaceutical companies in civil court.

“This report represents a new effort by OIG to compile in one document information about MFCU activities and results, and we anticipate issuing annual reports for future years,” wrote OIG, which conducted 10 onsite reviews of MFCUs, publishing eight reports.

OIG relied on convictions from MCFU investigations to exclude more than 1,000 providers from federal healthcare programs in 2013, the report says.

In compiling the report, OIG says it found some Medicaid managed care organizations may lack incentive to refer providers suspected of fraud to MCFU and that new rules under the Affordable Care Act require more coordination between MCFUs and state Medicaid agencies.

The OIG issued regulations to allow data mining by MCFUs and proposed more authority for the units to investigate allegations of patient abuse and neglect.