The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU or Unit). This MFCU Fiscal Year (FY) 2015 Annual Report highlights statistical achievements from the investigations and prosecutions the 50 MFCUs conducted for FYs 2011 through 2015. The report also identifies improvements made in Unit operations.
In FY 2015, Units reported 1,553 convictions, nearly one-third of which involved personal care services attendants. Fraud cases accounted for 71 percent of the 1,553 convictions. Units reported 731 civil settlements and judgements, with pharmaceutical manufacturers making up over a third of Unit settlements. Units also reported $744 million in criminal and civil recoveries.
According to the report the number of convictions, settlements and judgments, and recoveries for Personal Care Services Agency showed 22 criminal convictions with recoveries in the amount of $1,718,223 and 27 civil cases of settlements/judgements in the amount of $3,960,381 in recoveries. The report also shows 439 “other individual providers” types who were criminally convicted of fraud with recoveries of $7, 302,308; and 19 civil case settlements and judgments of $88,484 in recoveries.
This report will place all attendant services under scrutiny. We should expect that Texas Inspector General Bowen will be making personal care services an integrity priority in 2017.
You can download the complete report.