Government expects to recover $1.9 billion for 2016 Medicaid fraud cases

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The HHS OIG also released an interactive map, pictured here, as part of the data package.
The HHS OIG also released an interactive map, pictured here, as part of the data package.

The federal government expects to recover almost $1.9 billion from Medicaid fraud, abuse and neglect cases that were settled or for which judgments were issued in 2016, according to new data that the Department of Health and Human Services Office of Inspector General released Monday.

Cases involving the OIG and Medicaid Fraud Control Units resulted in 18,730 investigations that led to 1,721 indictments or charges, 1,564 convictions and 998 settlements or judgments in fiscal year 2016, according to the data.

MFCUs are state-based agencies that investigate and prosecute provider fraud, as well as patient/resident abuse and neglect, in facilities accepting funds from the Medicaid program.

The newly released table presents by state total investigations, indictments/charges, convictions and civil settlements and judgments in fiscal year 2016, as well as recoveries, expenditures and number of government staff involved, as of Jan. 26.

  • Indiana, California, Ohio and Texas had the most investigations.
  • California, Ohio, New York and Texas had the highest number of indictments and charges.
  • California, Ohio and New York and Pennsylvania had the most total convictions.
  • Colorado, New York, Massachusetts and California had the most settlements and judgments.
  • New York, Texas, Florida and California had the highest dollar amount in total recoveries.
  • New York, California, Texas and Florida had the greatest number of staff on board.

Although the reported information does not specify the settings where fraud, abuse or neglect occurred (such as assisted living communities, skilled nursing facilities and hospitals), an accompanying podcast cites a case involving assisted living communities that McKnight's Senior Living reported in October.

“Working with the Florida MFCU, we charged 10 owners of … Miami-Dade county assisted living facilit[ies] with healthcare fraud and receiving illegal cash kickbacks in return for referring residents to a specific pharmacy,” Shimon Richmond, special agent in charge of the HHS OIG's Miami region, said in the podcast. “The pharmacy owner was sentenced not long ago to federal prison and ordered to pay back more than $1 million to the Florida Medicaid program. This ring was exposed by joint efforts between OIG agents and MFCU agents working in undercover capacity.”

The HHS OIG also released an interactive map as part of the data package.

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