2014 OIG Data – State MFCUs More Active

 By Michael D. Miscoe JD, CPC, CASCC, CUC, CPCO, CCPC, CHCC

The HHS OIG recently published its annual report  (OEI-06-15-00010) regarding enforcement activities by state Medicaid Fraud Control Units (MFCUs).  During Fiscal year 2014, state MFCUs obtained 1,318 criminal convictions and 874 civil settlements and judgments.

According to the HHS OIG report, criminal convictions most commonly involved home healthcare aides, certified nursing aides, and other medical support staff. Specifically, home health aids represented 30 percent of the criminal convictions, up from 26 percent in FY 2013; certified nursing aides represented 9 percent, up slightly from FY 2013’s 8 percent; and other medical support represented 7 percent, the same amount as in FY 2013.  Of the criminal convictions, 73 percent were for fraud offenses and 27 percent involved patient abuse and neglect, OIG said.  Recoveries from the criminal cases reached nearly $300 million in FY 2014, according to the report.

Of the 874 civil settlements and judgments that MFCUs obtained, 52 percent involved pharmaceutical manufacturers, 10 percent pharmacies, and 8 percent suppliers of durable medical equipment. Recoveries from civil cases totaled $1.7 billion, OIG said, 69 percent of which were related to global settlements.

Demonstrating an increased willingness to utilize its exclusion authority, the OIG report noted that MFCU convictions led to the exclusion of 1,337 providers from federal health care programs, which was a 31 percent increase over the previous year.

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Michael Miscoe

Mr. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA has over 20 years of experience in healthcare coding and over sixteen years as a compliance expert, forensic coding expert and consultant. He has provided expert analysis and testimony on a wide range of coding and compliance issues in civil and criminal cases and his law practice concentrates exclusively on representation of healthcare providers in post-payment audits as well as with responding to HIPAA OCR issues. He has an extensive national speaking background and has been published in numerous national publications on a variety of coding, compliance and health law topics.

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