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

Issued on  | Posted on  | Report number: OEI-09-20-00110

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.

Key statistics from the report include:

  • 1,527 Convictions
    • 1,111 Fraud
    • 416 Patient Abuse or Neglect
  • 658 Civil Settlements and Judgments
  • 1235 Individuals or Entities Excluded from federally funded health programs
  • Civil Recoveries
    • 28% Nonglobal Cases
    • 72% Global Cases
  • $305 Million Criminal Recoveries
  • $1.6 Billion Civil Recoveries
  • $1.9 Million Recovered
    • MFCUs recovered $6.41 for every $1 spent