Tuesday, April 1, 2014

OIG MFCU FY 2013 Report

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG), released its annual report, Medicaid Fraud Control Units FY 2013 Annual Report, which highlights statistical achievements from the investigations and prosecutions conducted by the 50 Medicaid Fraud Control Units (MFCUs) nationwide.

According to the report, MFCUs reported a total of 1,341 convictions in cases involving Medicaid fraud and patient abuse and neglect. Criminal convictions involved a variety of provider types, most notably home health agencies; and recoveries reached nearly $1 billion. MFCUs also obtained 879 civil settlements and judgments, and civil recoveries totaled over $1.5 billion. Civil settlements and judgments involved a variety of provider types, most notably pharmaceutical companies; and recoveries reached over $1.5 billion.

Further, the OIG took up further action with 1,000 Medicaid providers due to provider exclusions violations. Further, the report found that there are a lack of fraud referrals to MFCUs regarding Medicaid Managed Care Organizations (MCOs), and there is concern that MCOs may not have incentive to refer providers suspected of fraud.

To obtain a copy of the complete report go to OIG’s website.

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