Provider types with highest number of convictions for fraud under Medicaid 2019

In 2019, the criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 1,111 convictions for fraud. Nearly 500 convictions involved PCS (personal care services) attendants and other home care aides, which was significantly more than any other provider type.

Total criminal convictions increase

MFCUs investigate and prosecute Medicaid provider fraud, but also patient abuse or neglect in nursing homes and care facilities. Convictions involving nurses or physician assistants accounted for nearly a quarter of all the convictions for abuse or neglect in 2019. Overall, the criminal cases opened by MFCUs resulted in 1,527 convictions in 2019, which was slightly higher than the previous year.

Who is eligible for Medicaid?

Medicaid is a health care program that helps eligible groups of people obtain health insurance. The plan primarily serves low-income groups, including children, parents, and pregnant women. Historically, low-income adults without children were excluded from the program. However, the Affordable Care Act – signed into law by President Obama in 2010 – created the opportunity for states to expand their Medicaid programs to cover nearly all low-income adults under the age of 65.

Provider types with the highest number of convictions for fraud under Medicaid in FY 2019

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Sources

Release date

March 2020

Region

United States

Survey time period

fiscal year 2019

Supplementary notes

PCS = personal care services.
LPN = licensed practical nurse.
RN = registered nurse.
NP = nurse practitioner.
PA = physician assistant.
CNA = certified nurse aide.

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Statistics on "Medicaid/CHIP"

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