State Medicaid Fraud Control Units
Fiscal Year 2012 Grant Expenditures And Statistics
In fiscal year (FY) 2012, the combined Federal and State grant expenditures for the State Medicaid Fraud Control Units (MFCU) totaled $ 217.3 million, of which Federal funds represented $162.9 million. The 50 MFCUs employed 1,901 individuals.
Collectively in FY 2012,1 the MFCUs reported conducting 15,545 investigations, of which 11,663 were related to Medicaid fraud and 3,882 were related to patient abuse and neglect, including patient funds cases.2 Investigations resulted in 1,373 individuals being indicted or criminally charged: 994 for fraud and 379 for patient abuse and neglect. In total, 1,344 convictions were reported in FY 2012, of which 983 were related to Medicaid fraud and 361 were related to patient abuse and neglect. The total number of civil judgments and settlements for the fiscal year was 824.
In FY 2012, States reported $2.9 billion in recoveries for both civil and criminal cases handled by the 50 MFCUs.3 In addition to other significant accomplishments by the MFCUs in prosecuting patient abuse and detecting and deterring fraud, this translates to a return on investment (ROI) of $13.54 per $1 expended by the Federal and State Governments for MFCU operations.4
The MFCUs refer to the Office of Inspector General (OIG) a significant number of cases for possible exclusion from participation in Medicare, Medicaid, and other Federal health care programs. In FY 2012, 747 of the 3,131 OIG exclusions were based on referrals made to OIG by MFCUs.
With the exception of the MFCU grant expenditures and exclusion information, which are maintained by OIG, these totals are based on information supplied by the MFCUs and have not been independently verified by OIG.
1Information on this page was revised in February 2014 based on revised numbers reported by several MFCUs.
2Total investigations are defined as the total number of open investigations at the end of the fiscal year.
3Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections. Recoveries may involve cases that include participation by other Federal and State law enforcement agencies.
4ROI is calculated as the total dollar amount of recoveries in both civil and criminal cases divided by the total amount of grant expenditures by Federal and State governments.
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