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Medicaid Fraud Control Units Annual Report: Fiscal Year 2025

Issued on  | Posted on  | Report number: OEI-09-26-00140

Report Materials

Why OIG Did This Review

  • The Department of Health and Human Services Office of Inspector General (OIG) is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU).
  • This MFCU fiscal year (FY) 2025 annual report highlights case outcomes and other data trends related to investigations and prosecutions that the 53 MFCUs conducted.
  • The report’s webpage also identifies beneficial practices from prior OIG onsite reports that may be useful to other MFCUs.
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What OIG Found

MFCUs recovered $4.64 for every dollar spent by States and the Federal Government. Combined recoveries from criminal and civil cases totaled almost $2 billion for FY 2025. Criminal recoveries from convictions totaled $1.3 billion and civil recoveries totaled $706 million. MFCUs also reported 674 civil settlements and judgments for FY 2025. Pharmaceutical manufacturers accounted for more civil settlements and judgments than any other provider type. For FY 2025, MFCUs reported 1,185 convictions. MFCU cases resulted in 856 convictions for fraud and 329 convictions for patient abuse or neglect. Significantly more convictions for fraud involved personal care services attendants than any other provider type. The categories of nurse’s aide and nurse had the highest numbers of convictions for patient abuse or neglect. MFCU convictions led to OIG exclusions of 900 individuals and entities from Federal health care programs, broadening the impact of MFCU convictions. For FY 2025, MFCUs reported receiving a total of 5,991 fraud referrals from managed care entities.

Additional Information

The Statistical Chart and data about Case Outcomes and Open Cases can be sorted and filtered. To do this, click on the links below to download the Excel file, then save a copy locally.

To work with the spreadsheets, go to the Review tab and select Unprotect Sheet.

Report Type
Evaluation
HHS Agencies
Medicaid Fraud Control Unit
Issue Areas
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Target Groups
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Financial Groups
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Notice

This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.