Tuesday, April 3, 2018

OIG Report Summarizing Activity by Medicaid Fraud Control Units

Lilly Hummel


The Department of Health and Human Services Office of Inspector General (OIG) released its Fiscal Year 2017 annual report summarizing activity by the Medicaid Fraud Control Units (MFCUs), including recoveries from assisted living communities and nursing centers. MFCUs are operated by each state to investigate and prosecute Medicaid provider fraud and patient abuse or neglect. For this report OIG analyzed the annual statistical data on case outcomes—such as convictions; civil settlements and judgments; and recoveries—that the 50 MFCUs submitted for fiscal year 2017.

Across all its investigations, the number of criminal convictions remained similar to prior years, the number of criminal recoveries nearly doubled, and the number of civil settlements, judgements and recoveries each declined. The report breaks out a variety of data by type of provider, including assisted living communities and nursing centers. While there were not a high number of convictions or judgments against these two provider settings, recoveries reached as high as approximately $1.2million for civil recoveries for fraud against nursing centers across 11 judgments or settlements.

The report also summarizes reports issued between 2012-2017 that summarize MFCU best practices for other Units to consider.

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