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At A Glance: Medicaid Fraud Control Units Fiscal Year 2020 Annual Report

Issued on  | Posted on  | Report number: OEI-09-21-00120

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. The Office of Inspector General (OIG) 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 53 MFCUs submitted for fiscal year 2020. In June 2020, OIG also administered a survey to all MFCUs about the effects of the COVID-19 pandemic on MFCU operations.

Key statistics from the report include:

  • 1,017 Convictions
    • 774 Fraud
    • 243 Patient Abuse or Neglect
  • 786 Civil Settlements and Judgments
  • 928 Individuals or Entities Excluded from federally funded health programs
  • Civil Recoveries
    • 26% Nonglobal Cases
    • 74% Global Cases
  • $173 Million Criminal Recoveries
  • $855 Million Civil Recoveries
  • $1.0 Billion Recovered
    • MFCUs recovered $3.36 for every $1 spent