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Provider types with high number of convictions for abuse/neglect under Medicaid 2019

The criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 416 convictions for abuse or neglect in nursing homes and care facilities in 2019 – the highest number since 2015. Nearly 100 convictions involved nurses or physician assistants, while an additional 86 convictions involved nurse aides.

Most criminal convictions are for fraud

MFCUs investigate and prosecute fraud and patient abuse or neglect by health care providers in the administration of the Medicaid program. Overall, there were 1,527 criminal convictions in 2019, which was consistent with previous years. Fraud convictions surpassed 1,000 for the fifth consecutive year, and close to 500 of those cases involved PCS (personal care services) attendants and other home care aides.

How do criminal cases work?

The journey that leads to a criminal conviction starts with MFCUs being made aware of a possible case – a referral may come from an external source such as a state Medicaid agency or a member of the public. The case is reviewed for validity, and if the claims are substantiated, the MFCUs will gather further evidence and conduct an investigation. As prosecutors, the MFCUs may file a criminal complaint that could lead to a conviction. MFCUs have proven to be very successful and recovered more than 300 million U.S. dollars from criminal convictions in 2019.

Provider types with the highest number of convictions for abuse or neglect 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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