Medicaid Fraud Control Units Recovered $1.8 Billion in 2016

The Office of Inspector General (OIG) has released national and state-by-state data of investigations, convictions, settlements, and recoveries of Medicaid fraud by Medicaid Fraud Control Units (MFCUs) in 2016.  Medicaid Fraud Control Units operate in 49 states (all but North Dakota) and the District of Columbia, and are typically part of the state attorney general’s office.

In 2016, MFCUs were credited with 1,564 convictions (1,160 involving fraud and 404 involving abuse or neglect), 998 civil settlements and judgments, and $1.88 billion in recoveries ($368 million of which were criminal recoveries).  MFCU civil settlements in 2016 represented a more than twenty four percent increase from the number of civil settlements in 2015 (731).

“… [W]hile we hear a lot about Medicare Fraud, involving the program for the elderly and the disabled, total taxpayer costs are actually higher in Medicaid, than in Medicare, with total yearly expenditures for Medicaid of over $500 billion dollars,” said Richard Stern, OIG Director of Program Oversight for Medicaid Fraud Units, in a recent podcast.

According to the newly released data, at the end of fiscal year 2016, there were a total of 18,730 open MFCU investigations nationwide, with over eighty percent of those open investigations involving allegations of fraud.  All indications suggest that MFCUs will continue to maintain and expand their enforcement activities in 2017.