OIG Reports MFCU Statistical Data For Fiscal Year 2015

Posted On Tuesday, February 23, 2016
By: James W. Kraus

On February 17, HHS/OIG released the statistics for Medicaid Fraud Control Unit (MFCU) activities in FY 2015, providing consolidated statistics for all MFCUs, as well as the totals for each of the reporting 49 states and the District of Columbia.  According to the report, in FY 2015 MFCUs conducted 14,441 fraud investigations, 1,387 providers were criminally charged with Medicaid fraud, and 1,097 were convicted.

OIG also reported that during FY 2015 MFCUs were responsible for obtaining 795 settlements and judgments, with $744,880,347 in total recoveries.  It is important to note that “recoveries” are defined as the amount of money that defendants are required to pay as a result of a settlement or judgment in criminal and civil cases, and may not reflect actual collections. 

Criminal cases accounted for $348,154,830 of the total MFCU recoveries in 2015.  The remainder was made up of civil recoveries, with $146,926,639 in “global” recoveries and $249,798,878 in “other” recoveries. “Global” recoveries are derived from civil settlements or judgments involving DOJ and a group of state MFCUs, and are facilitated by the National Association of Medicaid Fraud Control Units. 

MFCUs operate as the principal investigators and prosecutors of Medicaid Provider Fraud.  Operating in 49 states and the District of Columbia, usually as part of a state attorney general’s office, MFCUs employ teams of investigators, attorneys and auditors.  OIG exercises oversight for the MFCUs, and annually recertifies each MFCU based on an assessment of each MFCU’s performance.  It is as part of this oversight that OIG annually publishes this statistical data.

The statistical report and corresponding map with the statistics for each reporting state can be found here.