Last month, OIG released its Medicaid Fraud Control Units (MFCUs) report for Fiscal Year (FY) 2017. MFCUs investigate and prosecute Medicaid provider fraud and patient abuse and neglect and are jointly funded by the federal and state governments. Unless granted a waiver from HHS, each state is required to operate a MFCU. According to OIG, MFCUs recovered $1.8 billion in FY 2017, with an estimated return on investment of $6.52 recovered for every $1 spent. Combined federal and state expenditures on MFCUs for FY 2017 totaled $276 million, approximately $207 million of which represented federal funds.

Several significant cases impacted the MFCU results. For example, criminal recoveries almost doubled as compared to last year but the majority of this difference was attributable to the Texas MFCU, which prosecuted a large case involving a doctor and other codefendants who defrauded Medicaid and Medicare by improperly recruiting individuals and falsifying medical documents. Additionally, one New York case was responsible for $25.2 million of the $28.4 million in drug diversion recoveries.

OIG highlighted various practices observed at different state MFCUs that may be beneficial for other MFCUs to adopt. In particular, OIG noted that several MFCUs have focused on managed care by adopting strategies such as establishing regular meetings with Medicaid Managed Care Organizations.

To view the OIG report, click here.