Why OIG Did This Review
– The Department of Health and Human Services Office of Inspector General (OIG) is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU).
– This MFCU fiscal year (FY) 2025 annual report highlights case outcomes and other data trends related to investigations and prosecutions that the 53 MFCUs conducted.
– The report’s webpage also identifies beneficial practices from prior OIG onsite reports that may be useful to other MFCUs.
What OIG Found
MFCUs recovered $4.64 for every dollar spent by States and the Federal Government. Combined recoveries from criminal and civil cases totaled almost $2 billion for FY 2025. Criminal recoveries from convictions totaled $1.3 billion and civil recoveries totaled $706 million. MFCUs also reported 674 civil settlements and judgments for FY 2025. Pharmaceutical manufacturers accounted for more civil settlements and judgments than any other provider type. For FY 2025, MFCUs reported 1,185 convictions. MFCU cases resulted in 856 convictions for fraud and 329 convictions for patient abuse or neglect.