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Medicaid Recovered $1.8B in 2017

By John Commins  
   April 02, 2018

Total civil recoveries are down $400 million from fiscal year 2016, but in line with the five-year annual average of $1.2 billion.

More than 1,500 people or entities were convicted of Medicaid fraud or abuse and neglect in 2017, and prosecutors collected $1.8 billion in civil and criminal recoveries, federal auditors said in their annual report on the $565 billion program.

In addition, 1,181 care givers or entities were kicked off the program in 2017 as a result of fraudulent or abusive behavior, according to the report, which was published by the Department of Health and Human Service's Office of the Inspector General.

The $1.1 billion in civil recoveries in 2017 is down from the $1.5 billion collected in 2016 but is roughly in line with a five-year average of $1.2 billion.  Of the 961 civil settlements and judgements in 2017, 426 (44%) involved pharmaceutical manufacturers, led by the $465 million Mylan settlement.

The 1,528 total convictions for fraud, abuse and neglect in 2017 are roughly the same as in 2015 and 2016. However, the $693 million in criminal recoveries in 2017 were almost double those collected in 2016, largely owing to a single $519 million recovery from a wide-ranging criminal enterprise in Texas.

Of the 1,157 fraud convictions in FY 2017, 523 (45%) involved personal care services attendants and agencies; 36 involved family practice physicians; 88 involved nurses, licensed practical nurses, physician assistants or nurse practitioners; 54 involved home health agencies; and 25 involved mental health facilities.

Of the 371 convictions for patient neglect or abuse, 112 involved nurses’ aides, or certified nursing assistants; 76 involved RNs, LPNs, PAs or NPs; 59 involved personal or home healthcare aides; 32 involved non-direct care staff; and 13 involved assisted living facilities.

The report is based on data collected from the mostly federally funded Medicaid Fraud Control Units, which operate in 49 states and the District of Columbia.

MFCUs recovered $6.52 for every $1 spent. The units operate on a combined $276 million annual budget, $207 million of which is funded by the federal government.

Medicaid represents about 17% of the $3.3 trillion annual national healthcare expenditure, according to HHS.

John Commins is a senior editor at HealthLeaders.


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