Provider types with high number of convictions for abuse/neglect under Medicaid 2022

The criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 381 convictions for patient abuse or neglect in nursing homes and care facilities in 2022 – the cases are rising from the 2020 level. Of these, 149 convictions involved nurses or nurse's 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 1,017 criminal convictions in 2020, which was much lower than previous years. Fraud convictions also decreased in 2020, and 360 of those cases involved PCS (personal care services) attendants and agencies.

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 170 million U.S. dollars from criminal convictions in 2020.