State Medicaid Fraud Control Units Recovered $859 Million in 2018

The U.S. Department of Health and Human Services Office of Inspector General issued their “Medicaid Fraud Control Units Fiscal Year 2018 Annual Report” this past week.

In 2018, MFCUs around the country got back some $859 million from criminal and civil recoveries. This represents $2.92 for every dollar the MCFU’s spent. There were some 1,503 criminal convictions and 810 civil settlements and judgments against Medicaid providers.

Criminal and civil statistics by provider

The most interesting part of the report, which does not break down the recoveries by state, is its appendix that details the national breakdown of criminal and civil recoveries by provider class.

Across the nation, sixteen dentists were convicted and there were $11 million in criminal recoveries. Civilly, there were 43 judgments/settlements against dentists totaling almost $28 million. Not pretty.

Doctors were broken down by medical specialty. Seventeen family practice physicians were convicted with $36 million recovered on the criminal side. Three family practice doctors ponied up a million in settlements. Seventeen “Other MD/DO” were criminally convicted with a huge $71 million collected. Civilly, another seventeen doctors settled for $6.6 million.

There were eight criminal convictions of hospitals with a total of $37 million in recoveries.  Civilly civil judgments/settlements against hospitals totaled $12 million.

217 pharmaceutical manufacturers were dinged $311 million in civil settlements/judgments.

We’ve separated out this appendix which also includes tables for open investigations for download.

The whole report is available here.

OIG 2018 breakdown

Leave a Reply

Your email address will not be published. Required fields are marked *