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Medicaid Fraud Control Units fiscal year 2022 annual report
Medicaid Fraud Control Units fiscal year 2022 annual report
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, March 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- legislation & jurisprudence
Fraud -- prevention & control
Fraud -- statistics & numerical data
Government Regulation
Medicaid
United States - Genre(s):
- Technical Report
- Abstract:
- Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. The Social Security Act (SSA) requires each State to effectively operate a MFCU, unless the Secretary of Health and Human Services (HHS) determines that (1) the operation of a Unit would not be cost-effective because minimal Medicaid fraud exists in a particular State; and (2) the State has other adequate safeguards to protect enrollees from abuse or neglect.2 In fiscal year (FY) 2022, all 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands operated MFCUs. MFCUs are funded jointly by the Federal and State Governments. Each Unit receives a Federal grant award equivalent to 90 percent of total expenditures for new Units and 75 percent for all other Units. In FY 2022, combined Federal and State expenditures for the Units totaled approximately $343 million, of which approximately $257 million represented Federal funds. As illustrated in Exhibit 1, MFCU cases typically begin as referrals from external sources or are generated internally from data mining. MFCU staff review referrals of possible fraud and patient abuse or neglect to determine the potential for criminal prosecution and/or civil action. If the Unit accepts a referral for investigation, the case may result in various possible outcomes. Criminal prosecutions may result in convictions; civil actions may result in civil settlements or judgments. Both criminal prosecutions and civil actions may include the assessment of monetary recoveries. The Office of Inspector General (OIG) has the authority to exclude convicted individuals and entities from any federally funded health care program on the basis of convictions referred from MFCUs.8 In addition to achieving these case outcomes, Units may also make programmatic recommendations to their respective State Governments to help strengthen program integrity and efforts to fight patient abuse or neglect.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (26 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918697338106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918697338106676