State Medicaid Fraud Control Units
Fiscal Year 2009 Grant Expenditures And Statistics
In FY 2009, the Department of Health and Human Services (HHS) awarded $189.8 milion in Federal grant funds to 50 State Medicaid Fraud Control Units (MFCUs), which employed a total of 1,835 individuals.
Collectively, in FY 2009, the MFCUs reported 26,744 total investigations, of which 17,090 were related to Medicaid fraud and 9,654 were related to patient abuse and neglect, including patient funds cases. These cases resulted in 1,539 individuals being indicted or criminally charged, including 960 for fraud and 579 for patient abuse and neglect, including patient funds cases. In total, 1,331 convictions were reported in FY 2009, of which 819 were related to Medicaid fraud and 512 were related to patient abuse and neglect, including patient funds cases.
For both civil and criminal cases handled by the 50 MFCUs, $1.3 bilion was recovered to the program. In addition to the significant accomplishments of the MFCUs in prosecuting patient abuse and detecting and deterring fraud, this amount translates to a return on investment of $5.23 per $1.00 contributed by both the Federal and State governments for the operation of the MFCUs. The total number of civil judgments and settlements for the fiscal year was 642.
The MFCUs refer to the OIG a significant number of cases for possible exclusion from participation in Medicare, Medicaid, and other Federal health care programs. In FY 2009, of the 2,556 OIG exclusions, 793 were based on referrals made to OIG by MFCUs.
With the exception of the total grant award and exclusion information, which are maintained by OIG, these totals are based on information supplied by the MFCUs and have not been independently verified by OIG. The MFCUs maintain separate case information for "patient abuse and neglect" as well as for "patient funds" cases, which were included by OIG as a single total.
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Priority recommendations summarized.
OIG planned projects.
Significant OIG activities in 6-month increments.