Medicaid Fraud Control Unit FYE 2013 Report

Medicaid Fraud Control Unit Report for 2013 was released last week by the Office of the Inspector General for the U.S. Department of Health and Human Services.  Among the top 10 highlights were:

1. There were 879 civil settlements totaling more than $2.5 billion dollars based on Medicaid Fraud Control Unit (MCFU) investigations and prosecutions
2. Virginia MCFU recovered almost half of the national total in connection with settlement with Abbot Laboratories for marketing  Dapokate for uses not approved by the FDA as safe and effective; illegal marketing to nursing homes; and illegal remuneration paid to long-term care pharmacies and facilities.
3. MCFUs in Texas ($196 million), Louisiana ($187 million), New York ($134), Tennessee($78 million), California ($57 million), and Illinois ($60 million) all recovered more than $50 million dollars.
4. MCFUs in Florida, Ohio, Texas, California, Indiana, New York, Mississippi, Massachusetts, and New York conducted the most investigations for FYE 2013.
5. 74% of the total criminal convictions in 2013 were based on fraud.
6. 26% of the total criminal convictions in 2013 were related to home health care aides
7. Pharmaceutical manufacturers accounted for 62% of the total civil settlements and judgments with MCFUs.
8. Pharmacies, Home Health Care Agencies, Hospitals, and Nursing facilities entered into a substantial amount of civil settlements and judgments with MCFUs.
9. OIG excluded 1022 subjects as a result of MCFU investigations which is a substantial increase from 2012 (746 subjects).
10. The Report expressed concerns about the lack of fraud referrals from managed care organizations and emphasized that MCO’s are critical fraud referral sources given the amount of Medicare beneficiaries covered under managed care arrangements.

The Firm has experience representing health care providers in Medicaid fraud prosecutions and investigations. It is critical to retain an attorney that understands the scope and direction of these investigations. Please feel free to contact the Firm if you suspect or receive notice of a Medicaid fraud investigation.

Author: Andrew Feldman

Mr. Feldman represents professionals, corporations, health care providers, and health care marketers in government investigations and prosecutions throughout the United States. Mr. Feldman works tirelessly for his clients from the time an investigation begins until the time a jury renders a verdict.

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