In March, OIG released its annual Medicaid Fraud Control Units (MFCUs) report for Fiscal Year (FY) 2018.  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 an MFCU. 

According to OIG, MFCUs recovered $859 million in FY 2018, with an estimated return on investment of $2.92 for every $1 spent.  Notably, this represents a significant decrease from FY 2017 recoveries.  As previously reported, in FY 2017, MFCUs recovered $1.8 billion, with an estimated return on investment of $6.52 recovered for every $1 spent.  OIG attributed this decrease in part due to the occurrence of large monetary settlements in certain years.

In FY 2018, combined federal and state expenditures for MFCUs totaled approximately $294 million, of which $221 million represented federal funds.  OIG also noted that drug diversion convictions continue to increase. 

OIG’s report highlights various practices observed at different state MFCUs that may be beneficial for other MFCUs to adopt, including greater communication with other agencies, greater outreach activities, and focusing on managed care.

OIG’s report is available here.