The OIG has released its Medicaid Fraud Control Units Fiscal Year 2015 Annual Report, which compiles data on investigations and prosecutions by the 50 MFCUs. According to the OIG, MFCUs attained 1,553 convictions in FY 2015, the highest in the last five years. Almost one-third of these convictions involved personal care services attendants, and 71% represented fraud cases. There were also 731 civil settlements and judgments in FY 2015, including 279 involving pharmaceutical manufacturers (typically related to the marketing of drugs) and 54 involving pharmacies. MFCUs were responsible for a total of $744 million in criminal and civil recoveries in FY 2015, down significantly from the $1.5 billion to $2.6 billion range over the previous four years. The OIG attributes this decrease to "a national trend of declining civil health care fraud complaint settlements, especially those involving large pharmaceutical companies." Combined federal and state expenditures for MFCUs totaled approximately $251 million in FY 2015, $188 million of which represented federal funds.
This article is presented for informational purposes only and is not intended to constitute legal advice.
