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State Medicaid Fraud Control Units Recovered $1.3 billion in 2008

Ben Amirault, for HealthLeaders Media, August 13, 2009

The Office of Inspector General (OIG) issued a report on Aug. 7 that said state Medicaid Fraud Control Units (MFCU) recovered $1.3 billion in court-ordered restitution, fines, civil settlements, and penalties for fiscal year 2008.

The report went on to say the MCFUs also obtained 1,314 convictions; achieved 971 civil settlements and/or judgments, and excluded 755 providers from participation in the Medicare, Medicaid, and other Federal health care programs in FY 2008.

According to the report, the mission of the MFCUs is to investigate and prosecute Medicaid provider fraud and patient abuse and neglect. Forty-nine states and the District of Columbia have MFCUs. The only state without an MFCU is North Dakota.

The report highlights a settlement between the New York MFCU and Staten Island University Hospital (SIUH) and SIUH Systems, Inc., in which SIUH agreed to pay the Medicaid program $24.8 million. The settlement resolved allegations that SIUH Systems billed Medicaid for detoxification treatment provided in a special unit of the hospital without a state-issued certificate of operation.


Ben Amirault is an Editorial Assistant for the revenue cycle division of HCPro. He manages the Compliance Monitor e-newsletter and has developed a number of online learning modules. He can be reached at bamirault@hcpro.com..

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