HHS’s Office of the Inspector General (OIG) released their annual report for the Fiscal Year 2013, which highlights statistical achievements from the Medicaid Fraud Control Unit investigations and prosecutions nationwide. Medicaid Fraud Control Units (MFCU) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities.
The report’s methodology include gathering information Quarterly Statistical Reports form each MCHU and other sources, including HHS OIG exclusion data and information gathered through onsite reviews. Most of the statistical information was current through January 31, 2014. In this post, we will focus on the state of Ohio and how fraud cases there compare with other states.
The full annual report can be viewed here. OIG also maintains updated MCFU information on their website, which includes an interactive map with statistics on each unit (Note:
Map currently shows 2012 Fiscal Year data).
In terms of Medicaid fraud, here are the statistics for the State of Ohio:
- 1,049 investigations were reported in 2013, with 153 of them resulting in a criminal charge or conviction.
- Nearly $6 Million was recovered as a result of the 148 criminal convictions in 2013.
- 90.2% (or 115) of the criminal convictions/charges were for Fraud and 9.8% (or 15%) for were for Patient Abuse/Neglect. (Fraud includes, health care fraud or conspiracy to commit health care fraud, among other actions.)
- Over $35 Million was recovered in Ohio through 21 Civil Settlements/Judgments.
Take a look at how Ohio compares to the rest of the nation.
- Ohio ranked first in the nation for the number of criminal indictments for the second year in a row with 148 out of the 1,341 indictments nationwide. Last year, Ohio’s MFCU indicted 146 individuals.
- The $41 Million in funds recovered by Ohio puts Ohio 11th out of 50 MCFUs in terms of largest amount of funds recovered. 49 states and the District of Columbia operate MCFU’s. Virginia topped the list at $1,008,988,075 recovered. Texas, Louisiana and New York are the next highest with between $134 Million and $196 Million recovered in each of those states. Delaware is at the bottom of the list, with just $398,817 that was recovered.
- The Ohio MCFU employs 77 individuals – the only states who employ more people are California, Florida, New York, Texas and Virginia.
- Nationwide, 71% of investigations resulting in criminal convictions or charges were related to fraud. In Ohio, this percentage is a little lower at 66.8%.
- The 21 Civil settlements and judgments in Ohio represent 2.38% of the 879 reported nationwide. New York tops the list representing 7.84% of the civil settlements and judgments.
Overall, the total number of MFCU case outcomes nationwide, including criminal convictions and civil settlements and judgments, remained steady in 2013 compared to recent years. For the second year in a row, however the MFCUs recovered over $2 Billion in funds, which means they are doing something right.
Furthermore, when providers are convicted of program-related crimes, OIG excludes these individuals from federally funded health care programs, like Medicaid and Medicare. OIG data has shown that the number of MFCU cases that lead to exclusions by OIG has accounted for a quarter or more of all OIG exclusions in recent years.
Medicaid fraud is widespread and health care organizations that implement an effective audit strategy can affect these statistics and decrease fraud.
The MFCU’s are looking for criminals and will find them. For Ohio’s FQHCs, convictions for fraud could not only be devastating to the organization’s business and reputation, but have great financial impact as well.
