MFCUs Continue To Recover Funds Lost from Fraud
The work to limit fraud continues in the Medicaid program, and fiscal year 2021 had its fair share of settlements and convictions. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released the Medicaid Fraud Control Units (MFCUs) Fiscal Year (FY) 2021 Annual Report, which included more eye-opening statistics.
MFCUs investigate and prosecute Medicaid provider fraud and patient abuse or neglect. Each state is required to effectively operate a MFCU, except in specific circumstances, and they are funded by the federal and state governments. In FY 2021, all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands operated MFCUs. OIG oversees the MFCU grant program by recertifying units, conducting reviews and inspections of units, providing technical assistance, and monitoring key statistical data about unit caseloads and outcomes.
Total convictions resulting from MFCU cases increased from 1,017 in FY 2020 to 1,105 in FY 2021. In FY 2021, MFCU cases resulted in 780 convictions for fraud and 325 convictions for patient abuse or neglect, similar to the distribution in previous years. However, the FY 2020 and FY 2021 numbers are down from about 1,500 convictions reported annually in FYs 2017-2019.
MFCU convictions lead to the exclusion of individuals and entities from participation in federally funded health care programs, broadening the impact of those convictions. When MFCUs make referrals to OIG regarding convictions for fraud and patient abuse or neglect in their respective states, OIG has the authority to exclude those convicted individuals and entities from federally funded health care programs.
The MFCUs reported a substantial increase in FY 2021 compared to the previous year in criminal recoveries. In FY 2021, the amount of criminal recoveries was $857 million, compared to $173 million in FY 2020. OIG said that this increase was primarily the result of cases prosecuted by MFCUs in Virginia and Texas. In addition, MFCUs reported 716 civil settlements in FY 2021, which was comparable to the previous year’s number. The amount of civil recoveries was $826 million in FY 2021, again similar to the amount recovered in FY 2020.
OIG noted that despite challenges posed by the COVID-19 pandemic, the MFCUs continued to carry out their Medicaid program integrity functions. It also boasted that the FY 2021 total recoveries of $1.7 billion amounted to a return on investment of $5.36 for every $1 spent.
This program has proved its worth. It’s unlikely that fraud cases will end any time soon, but it’s good to know that this program is helping recover critical lost funds.
Join us for our following Thompson Grants event:
Federal Grants Forum | May 11-13, 2022 | Portland, Ore.
Federal Grants Forum | June 15-17, 2022 | Denver, Colo.
