Florida Medicaid Fraud Control Unit Reports More Than $67 Million in Recoveries for 2011

The Department of Health & Human Services (HHS) Office of the Inspector General (OIG) reports that in fiscal year 2011, the combined expenditures for the State Medicaid Fraud Control Units (MFCUs) totaled $208.6 million, of which federal funds represented $156.7 million. The 50 MFCUs employed 1,833 individuals.

Nationwide, in FY 2011, the MFCUs reported conducting 14,819 investigations, of which 10,685 were related to Medicaid fraud and 4,134 were related to patient abuse and neglect, including patient funds cases. Investigations resulted in 1,408 individuals being indicted or criminally charged: 1,011 for fraud and 397 for patient abuse and neglect. In total, 1,230 convictions were reported in FY 2011, of which 824 were related to Medicaid fraud and 406 were related to patient abuse and neglect.

In FY 2011, states reported $1.7 billion in recoveries for both civil and criminal cases handled by the 50 MFCUs. In addition to other significant accomplishments of the MFCUs in prosecuting patient abuse and detecting and deterring fraud, this translates to a return on investment of $8.39 per $1 expended by the federal and state governments for operation of the MFCUs. The total number of civil judgments and settlements for the fiscal year was 906.

In Florida, 704 investigations took place in 2011, which resulted in 90 indictments/charges, 85 convictions and 44 civil settlements/judgments. In total, the MFCU recovered more than $67 million.

The MFCUs refer to OIG a significant number of cases for possible exclusion from participation in Medicare, Medicaid and other federal health care programs. In FY 2011, 724 of the 2,662 OIG exclusions were based on referrals made to OIG by MFCUs.

With the exception of the MFCU grant expenditures and exclusion information, which are maintained by OIG, these totals are based on information supplied by the MFCUs and have not been independently verified by OIG.

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