OIG Medicaid Fraud

Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. The Department of Health and Human Services Office of Inspector General 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 50 MFCUs submitted for fiscal year 2018.

4 part graphic showing MFCUs at a glance in 2018: 1503 convictions (1109 fraud, 394 patient abuse or neglect); 974 individuals or entities excluded from federally funded health programs resulting in $314 million in criminal recoveries. And, 810 civil settlements and judgements; civil recoveries (67% global cases and 33% nonglobal cases) resulting in $545 million in civil recoveries; For a total of $859 million recovered (MFCUs recovered $2.92 for every $1 spent).

  • 1,503 Convictions
    • 1,109 Fraud
    • 395 Patient Abuse and Neglect
  •  810 Civil Settlements and Judgements
  • 974 Individuals or Entities Excluded
  • $859 Million Recovered