Regulation of Medicine


Medicaid Fraud Control Units Report Nearly $2 Billion in Total Recoveries for FY 2016

On March 6, 2017, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) published data regarding the enforcement activities of Medicaid Fraud Control Units (MFCUs) across the country during fiscal year 2016.

Nearly every U.S. state, (excluding North Dakota), and the District of Columbia, operate MFCUs, with the objective of investigating and prosecuting fraud, waste and abuse, (as well as patient abuse and neglect), within each state’s Medicaid program.

At the end of fiscal year 2016, there were a total of 18,730 open MFCU investigations nationwide, with over eighty percent of those open investigations involving allegations of fraud. The number of total MFCU investigations in 2016 represents a continuation of an upward trend in the number of open MFCU investigations for the last several years. Similarly, the number of MFCU civil settlements in 2016 (998) represents a more than 20% increase from the number of civil settlements in 2015 (795).

According to the newly released data, total expenditures by MFCUs in 2016 were $258,698,147 nationwide, which, when compared to the $1.8B in total recoveries, means that MFCUs recovered roughly $7.25 for every $1 spent on enforcement activities. Thus, MFCUs have provided a valuable return on the government’s investment in fraud and abuse enforcement activities, and all indications suggest that MFCUs will continue to maintain and expand their enforcement activities in 2017 and years to come.

By Scott Grubman, Esq., Chilivis, Cochran, Larkins & Bever, LLP



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