Tuesday, September 20, 2016

OIG Releases MFCU 2015 Annual Report

Dianne De La Mare

The US Department of Health, Office of Inspector General (OIG) has released a report, Medicaid Fraud Control Units FY 2015 Annual Report, that reports that Medicaid Fraud Control Units (MFCUs) reported 1,553 convictions.

Seventy-one percent of these convictions involved fraud and 29 percent involved instances of abuse or neglect. For the same time period, units reported 731 civil settlements and judgments and $744 million in criminal and civil recoveries. Nearly 1/3 of those convictions involved personal care services attendants or other home care aides. Eleven percent of those convictions were of nurse aides. Another 11 percent of those convictions were of licensed nurses, physician assistants or nurse practitioners. Drug diversion cases accounted for 8 percent of those convictions. Convictions over the past 5 years have increased, while the number of civil settlements and amount of recoveries have decreased.

Overall, recoveries from assisted living facilities was $125,813 for criminal allegations; and recoveries from nursing care centers was $1,682,058 for criminal allegations and $2,835,186 for civil allegations.

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