OIG

Medicaid Fraud Enforcement Trends By the Numbers

A new report from OIG details Medicare Fraud Control Unit (MCFU) enforcement activity in fiscal year 2018. Bottom Line on Top: The numbers were pretty consistent with previous trends with little in the way of any dramatic changes. Here are the key numbers for FY 2018:

  • 1,503: Total convictions, including;
    • 1,109: Convictions due to fraud; and
    • 394: Convictions due to patient abuse or neglect;
  • 974: Individuals or entities excluded from federally funded health programs;
  • 810: Civil settlements and judgments;
  • $859 million: Total amount recovered, including;
    • $314 million: Criminal recoveries; and
    • $545 million: Civil recoveries.

Convictions Trends
The total number of convictions has remained relatively steady for the past four years, after a jump from 2014 to 2015.

Year Medicaid Convictions
2014 1,318
2015 1,553
2016 1,564
2017 1,528
2018 1,503

Source: U.S. Department of Health and Human Services, Office of Inspector General

For the past five years, fraud convictions have accounted for approximately 73% of all convictions.

Convictions of personal care service (PCS) attendants and agencies for fraud were significantly higher than for any other provider type in FY 2018: 496 convictions.

Other 2018 Data
Criminal recoveries, which spiked in 2017, are back in line with previous years.

The number of civil settlements and judgments is slightly lower than in previous years. Similarly, in FY 2018, civil recoveries decreased in comparison to what happened in three of the last four years.

Other Noteworthy Numbers
In FY 2018, MCFUs:

  • Had a conviction rate of 90.3%; and
  • Recovered $2.92 for every $1 they spent.
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