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Recoveries and expenditures from fraud cases under Medicaid 2019

Approximately 1.9 billion U.S. dollars was recovered by the Medicaid Fraud Control Units (MFCUs) in 2019, nearly 85 percent of which came through civil recoveries. The remaining 15 percent was recovered through criminal convictions.

Civil recoveries surpass one billion U.S. dollars

Medicaid fraud is a widespread problem in the United States, and the role of the MFCUs is vitally important in combatting the exploitation of the program – criminal cases opened by MFCUs led to around 1,500 convictions in 2019. Criminal recoveries totaled 305 million U.S. dollars in 2019 – slightly lower than the previous year – but civil recoveries increased by more than one billion U.S. dollars between 2018 and 2019.

Types of fraud and abuse cases

MFCUs investigate fraud and patient abuse or neglect in nursing homes and care facilities. If there is a legitimate claim, MFCUs may file a criminal prosecution, a civil file, or even both. Fraud cases involve wrongdoings such as tax evasion, false claims, or billing for services that were never provided. Examples of patient abuse or neglect include a provider failing to supply the most basic of care or finding evidence of inadequate patient supervision. The continued success of the MFCUs can act as a major deterrent in the fight against Medicaid fraud and abuse.

Recoveries and expenditures regarding fraud cases under Medicaid in FY 2019, by type (in million U.S. dollars)*

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Sources

Release date

March 2020

Region

United States

Survey time period

fiscal year 2019

Supplementary notes

* Including fraud, abuse, and neglect cases.
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 agencies.
“Global” recoveries derive from civil settlements or judgments involving the U.S. Department of Justice and a group of State MFCUs and are facilitated by the National Association of Medicaid Fraud Control Units.
MFCU and Medicaid Expenditures include both State and Federal expenditures.
MFCU = Medicaid Fraud Control Units.

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