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At A Glance: Medicaid Fraud Control Units Fiscal Year 2019 Annual Report

Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. The Department of Health and Human Services Office of Inspector General is the designated Federal agency that oversees and annually approves Federal funding for MFCUs through a recertification process. For this report, we analyzed the annual statistical data on case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 52 MFCUs submitted for fiscal year 2019.

4 part graphic showing MFCUs at a glance in 2019: 1527 convictions (1111 fraud, 416 patient abuse or neglect); 1235 individuals or entities excluded from federally funded health programs resulting in $305 million in criminal recoveries.  And, 658 civil settlements and judgements; civil recoveries (72% global cases and 28% nonglobal cases) resulting in $1.6 billion in civil recoveries;  For a total of $1.9 billion recovered (MFCUs recovered $6.41 for every $1 spent).