Medicaid Fraud Control Unit recoveries grow to $1.8B in FY 2016

Medicaid Fraud Control Units were responsible for more convictions and had more total civil and criminal recoveries in fiscal year 2016 than in the year prior, according to a recent report from HHS' Office of Inspector General.

Medicaid Fraud Control Units operate in 49 states and the District of Columbia, and are typically part of the state attorney general's office. North Dakota is the only state that doesn't have an MFCU. In exercising oversight for the MFCUs, the OIG assesses each unit's performance and compliance with federal requirements.

MFCUs were responsible for 1,564 convictions and had $1.8 billion in criminal and civil recoveries in FY 2016. That's compared to 1,553 convictions and $744 million in total recoveries in FY 2015. 

With 120 criminal convictions and 80 civil settlements and judgments, New York's MFCU reported $228.9 million in recoveries in FY 2016 — the most of any state. Florida had the second highest total recoveries in FY 2016 at $165.5 million.

Total MFCU recoveries were lowest in Hawaii in FY 2016. With five criminal convictions and 13 civil settlements and judgments, Hawaii's MFCU reported total recoveries of $1.9 million in FY 2016.

MFCUs were responsible for 1,721 criminal indictments in FY 2016. Fraud was the most common reason indictments were issued.

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