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Civil recoveries paid from fraud and abuse cases under Medicaid 2012-2019

Civil recoveries from Medicaid fraud and patient abuse cases topped 1.6 billion U.S. dollars in 2019 – the highest amount since 2014. Medicaid Fraud Control Units (MFCUs) had recovered 545 million U.S. dollars from civil cases in 2018.

Settlements reached with pharmaceutical companies

MFCUs were responsible for 658 civil settlements and judgments in 2019, around 160 of which involved pharmaceutical manufacturers. One particular global case involved a pharmaceutical manufacturer that agreed to pay a total of 700 million U.S. dollars to resolve claims relating to the marketing of a drug – around 500 million U.S. dollars went to the federal government and 200 million U.S. dollars to the states. MFCUs were also involved in a number of criminal prosecutions that resulted in 1,527 convictions for fraud and patient abuse.

What are global cases and settlements?

In 2019, nearly three-quarters of the 1.6 billion U.S. dollars in civil recoveries came from global civil cases. Global cases involve the efforts of the federal government and multiple state MFCUs, working together in a plan coordinated by the National Association of Medicaid Fraud Control Units. The remaining 460 million U.S. dollars was derived from other civil cases that see MFCUs working either independently or with the assistance of other law enforcement partners, such as county sheriffs’ offices.

Civil recoveries paid regarding fraud and abuse/neglect cases under Medicaid from FY 2012 to FY 2019

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Sources

Release date

March 2020

Region

United States

Survey time period

fiscal years 2012 to 2019

Supplementary notes

* Exact figure calculated from the statistical chart.
** Exact figure calculated from the statistical chart.
*** Exact figure calculated from the statistical chart.

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Statistics on "Medicaid/CHIP"

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