California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Calif. Top State in Recouping Funds From Medicaid Fraud

In fiscal year 2011, California recovered $388.26 million through Medicaid fraud and patient abuse investigations, as well as civil and criminal cases, according to a report from HHS Office of the Inspector General, FierceHealthcare reports.

The amount is the most recovered by any state that year.

National Findings

In total, states recovered $1.7 billion through Medicaid fraud and patient abuse cases in FY 2011.

Federal and state governments in FY 2011 spent $208.6 million on Medicaid Fraud Control Units, which investigate and prosecute fraud, patient abuse and neglect at health care organizations.

MFCUs in FY 2011 conducted 10,685 Medicaid fraud investigations -- which yielded 824 convictions -- and 4,134 investigations into suspected patient abuse and neglect, which yielded 406 convictions (Cheung, FierceHealthcare, 4/3).

Overall, federal and state governments recouped $8.39 for every dollar spent on the MFCUs, the report found (HHS OIG report summary, 4/3).

Top States for Recovering Medicaid Fraud

The states that recovered the most Medicaid fraud in FY 2011 were:

  • California ($388.26 million);
  • Texas ($190.87 million);
  • New York ($136.44 million);
  • Ohio ($82.48 million); and
  • Kentucky ($81.44 million) (FierceHealthcare, 4/3).
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