State Medicaid Fraud Control Units 2010 Performance Sucks

For the Fiscal Year 2010, State Medicaid Fraud Control Units performance sucks.  They only brought in $1.8 billion in recoveries of fraud, waste and abuse.

The reason I say they suck, and I shall say it again, suck, is because they should have done better.  There were no cases to recover Medicaid fraud in child welfare.  Each unit contains a handful of attorneys to cover the entire state.  There are always more recoveries in the civil division than the criminal because States do not have the manpower, and in many instances, do not have the statutory power in the criminal sector.

Compile the lack of statutory resources with very little, if any, access to representation for the indigent, and you have a formula that will prevent these units from doing what they should, and that is ending Medicaid fraud in child welfare.

And now, with the new Kirk ruling, totals for next fiscal year will be even smaller.  Thanks, SCOTUS!

State Medicaid Fraud Control Units
Fiscal Year 2010 Grant Expenditures And StatisticsStatistics

In fiscal year (FY) 2010, the combined Federal and State grant expenditures for the State Medicaid Fraud Control Units (MFCU) totaled $205.5 million, of which Federal funds represented $153.8 million. The 50 MFCUs employed 1,827 individuals.

Collectively, in FY 2010, the MFCUs reported conducting 13,210 investigations, of which 9,710 were related to Medicaid fraud and 3,500 were related to patient abuse and neglect, including patient funds cases.¹Investigations resulted in 1,603 individuals' being indicted or criminally charged: 1,048 for fraud and 555 for patient abuse and neglect. In total, 1,329 convictions were reported in FY 2010, of which 839 were related to Medicaid fraud and 490 were related to patient abuse and neglect.

In FY 2010, States reported $1.8 billion in recoveries for both civil and criminal cases handled by the 50 MFCUs.² In addition to other significant accomplishments of the MFCUs in prosecuting patient abuse and detecting and deterring fraud, this translates to a return on investment (ROI) of $8.98 per $1 expended by the Federal and State governments for operation of the MFCUs.³ The total number of civil judgments and settlements for the fiscal year was 1,077.

The MFCUs refer to OIG a significant number of cases for possible exclusion from participation in Medicare, Medicaid, and other Federal health care programs. In FY 2010, 942 of the 3,340 OIG exclusions were based on referrals made to OIG by MFCUs.

With the exception of the MFCU grant expenditures and exclusion information, which are maintained by OIG, these totals are based on information supplied by the MFCUs and have not been independently verified by OIG.

¹ For FY 2010, total investigations are defined as the total number of open investigations at the end of the fiscal year. For FY 2009, total investigations were defined as the total number of investigations that were opened over the course of the entire fiscal year.

² Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections. Recoveries may involve cases that include participation by other Federal and State law enforcement agencies.

³ For FY 2010, ROI is calculated as the total dollar amount of recoveries in both civil and criminal cases divided by the total amount of grant expenditures by Federal and State governments. For FY 2009, the denominator for calculating ROI was based on funds awarded, rather than actual grant expenditures.

State Medicaid Fraud Control Units Fiscal Year 2010 Grant Expenditures And Statistics