State Medicaid Fraud Control Units
Fiscal Year 2011 Grant Expenditures And Statistics
In fiscal year (FY) 2011, the combined Federal and State grant expenditures for the State Medicaid Fraud Control Units (MFCUs) totaled $208.6 million, of which Federal funds represented $156.7 million. The 50 MFCUs employed 1,833 individuals.
Collectively, in FY 2011, the MFCUs reported conducting 14,819 investigations, of which 10,685 were related to Medicaid fraud and 4,134 were related to patient abuse and neglect, including patient funds cases.1 Investigations resulted in 1,408 individuals being indicted or criminally charged: 1,011 for fraud and 397 for patient abuse and neglect. In total, 1,230 convictions were reported in FY 2011, of which 824 were related to Medicaid fraud and 406 were related to patient abuse and neglect.
In FY 2011, States reported $1.7 billion in recoveries for both civil and criminal cases handled by the 50 MFCUs.2 In addition to other significant accomplishments of the MFCUs in prosecuting patient abuse and detecting and deterring fraud, this translates to a return on investment (ROI) of $8.39 per $1 expended by the Federal and State governments for operation of the MFCUs.3 The total number of civil judgments and settlements for the fiscal year was 906.
The MFCUs refer to OIG a significant number of cases for possible exclusion from participation in Medicare, Medicaid, and other Federal health care programs. In FY 2011, 724 of the 2,662 OIG exclusions were based on referrals made to OIG by MFCUs.
With the exception of the MFCU grant expenditures and exclusion information, which are maintained by OIG, these totals are based on information supplied by the MFCUs and have not been independently verified by OIG.
1 Total investigations are defined as the total number of open investigations at the end of the fiscal year.
2 Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections. Recoveries may involve cases that include participation by other Federal and State law enforcement agencies.
3 ROI is calculated as the total dollar amount of recoveries in both civil and criminal cases divided by the total amount of grant expenditures by Federal and State governments.
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