OIG Issues Annual Report on Medicaid Fraud Control Units.

Date posted: October 4, 2016

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued its annual report on the 50 State Medicaid Fraud Control Units (MFCUs).  The Social Security Act requires states to operate MFCUs to investigate and prosecute Medicaid-related fraud, as well as patient abuse or neglect.  The report outlines accomplishments and improvements in MFCU operations from fiscal years (FYs) 2010 to 2015.  The OIG collected information from three sources, including annual statistical reports, quarterly statistical reports, and onsite review reports.

The OIG made the following findings:

  • MFCUs reported 1,553 convictions, 731 civil settlements, and $744 million in criminal and civil recoveries;
  • Roughly 71 percent of convictions in FY 2015 stemmed from fraud cases, while the remainder involved abuse or neglect;
  • The number of civil settlements and recovery amounts have decreased over the past five years, while the number of convictions has increased;
  • Of the 23 MFCUs receiving OIG recommendations to improve reporting processes, 20 addressed the recommendations through various methods, such as developing an automated case tracking system; and
  • All MFCUs receiving OIG recommendations to improve their Memorandums of Understanding with state Medicaid agencies and enhance their policies and procedures made the necessary updates and revisions.

The OIG report is available at:

https://oig.hhs.gov/oei/reports/oei-07-16-00050.pdf.

Department of Health and Human Services Office of Inspector General.  “Medicaid Fraud Control Units Fiscal Year 2015 Annual Report.”  OEI-07-16-00050.  13 Sept. 2016.

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