The United States Department of Health and Human Services, Office of Inspector General (OIG) released the Medicaid Fraud Control Units Fiscal Year 2016 Annual Report in May 2017. The Annual Report is based upon analysis of analytical information sent by the fifty Medicaid Fraud Control Units (MFCUs) ran throughout the nation, along with information sent to OIG every year for the function of recertifying each state’s MFCU for compliance with Federal requirements. MFCUs are normally part of a state’s Attorney General’s workplace and examine and prosecute Medicaid service provider scams and patient abuse or disregard in healthcare centers. MFCUs run at the state level in forty-nine states and the District of Columbia. The OIG workouts oversight over the fifty MFCUs.
The FY 2016 Annual Report sums up the outcomes of the examinations and prosecutions performed by the MFCUs for FY 2016. Inning accordance with the analytical information examined, the variety of Medicaid convictions, civil settlements, and judgments continued to increase in FY 2016, reaching a 5-year high. MFCUs reported 1,564 convictions, with scams cases representing seventy-four percent of the overall and patient abuse or disregard cases representing twenty-six percent. Practically half of the scams convictions included unlicensed suppliers.
Convictions including personal care providers were reported to be the biggest classification of convictions, with thirty-five percent (552 of 1,564) of the convictions including personal care services attendants, agents of personal care services firms, or other home care assistants. Of the 552 convictions, 500 included company scams and 52 included patient abuse or disregard.
The 2nd biggest classification of convictions included nursing care, with eleven percent (171 of 1,564) of overall convictions including certified useful nurses (LPNs), signed up nurses (RNs), doctor assistants (PAs), or nurse specialists (NPs). Another 10 percent of convictions (153 of 1,564) were of nurse helps. These convictions normally included patient abuse or disregard, the arrangement of health services without a license, and services that were billed but not rendered. Nurse Aides were reported as the supplier type that represented the best variety of patient abuse or disregard convictions.
The Annual Report likewise kept in mind an upward pattern from FY 2015 to FY 2016 in drug diversion cases including incorrect or incorrect claims to the Medicaid program. Drug diversion examinations normally include a service provider fraudulently billing Medicaid for a drug not provided to the designated recipient. In such cases, the drug is diverted from legal and clinically essential usages.
There were likewise 998 civil settlements and judgments reported. Practically half of the settlements (463 or 46%) were with pharmaceutical makers, the company type with the best variety of settlements and judgments. Inning accordance with the report, settlements with pharmaceutical makers usually associate with the marketing of prescription drugs. In addition, seventy settlements and judgments included labs, sixty-seven involved medical gadget makers and fifty-seven included retail and wholesale drug stores. An overall of $1.9 billion in criminal and civil healings was reported to be recuperated in the Annual Report.