The 50 Medicaid Fraud Control Units (MFCUs) obtained 1,205 convictions in 2007, and obtained more than $1.1 billion in court-ordered restitution, fines, civil settlements, and penalties in cases involving the False Claims Act, fraudulent billing, and patient abuse and neglect, according to the OIG's fiscal year 2007 annual report. MFCUs ensure that “particularly vulnerable beneficiaries” receive health care services, and address state legislatures regarding Medicaid needs, make recommendations to state Medicaid agencies, and work with federal and state law enforcement agencies on joint case investigations and prosecutions
HHS gave more than $169 million in federal grant funds to the MFCUs, and more than $2.1 billion in funding since 1978. The OIG excluded 3,308 individuals and entities from participating in the Medicare, Medicaid, and other federal health programs in 2007, and 805 of those exclusions were referrals to the OIG from the MFCUs.
The MFCUs have worked on cases of Medicaid fraud, overpayment, drug diversion, and abuse and neglect. In Louisiana, a dentist who shared an office with his father entered a plea of no contest to Medicaid fraud and his father returned $100,000 to the Medicaid program after it was discovered the son, non-Medicaid provider, was treating Medicaid patients and billing the program using his father's Medicaid provider number. In South Dakota, an assisted living center employee was ordering controlled medications from pharmacies and diverting them for his own use. The employee agreed to pay restitution to the victims and the state, and received a suspended imposition of sentence and was put on probation.
In the area of durable medical equipment (DME), a DME supplier reimbursed $1.5 million to the Medicaid program as settlement for allegations of False Claims Act violations and was excluded from participation in federally funded health care programs for five years. The DME submitted false billings for medical items that were never ordered and were not medically necessary. The items were allegedly for Medicaid residents in group homes.
In Arkansas, a noninsulin-dependent diabetic nursing home resident was found to have an infected wound with maggots in it. The resident's nursing home entered into a civil settlement with the MFCU, and paid $50,000 in civil money penalties.
Source: OIG Semi-Annual Report, June 23, 2008.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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