Medicaid Fraud Control Units Obtained Record Number of Convictions in 2024
Key Points:
- Assisted Living was a primary target for fraud and abuse
- Provider encounters with MFCUs match those with the DOJ and OIG
The Department of Health and Human Services, Office of Inspector General (OIG), oversees state-level Medicaid Fraud Control Units (MFCUs), which are typically housed within state Attorneys General offices. These units are responsible for investigating and prosecuting Medicaid fraud, abuse, and neglect. Their efforts help recover program funds and protect vulnerable Medicaid recipients, with oversight and funding provided by OIG. In FY 2024, MFCUs reported 1,151 convictions and recovered $1.4 billion, marking the highest total recoveries in the last 10 years. The number of civil settlements and judgments also rose to 493. Additionally, 1042 individuals and entities were excluded from participating in a federally financed health care program. The number of fraud convictions involving personal care service attendants were considerably higher than those for any other provider type. In 2024, MFCUs secured 21 criminal convictions related to abuse, neglect, and fraud involving residents of assisted living facilities. Investigations of this type contributed to record-breaking levels of convictions and financial recoveries. At the end of 2024, there were 384 active criminal and civil cases involving assisted living communities. Most of the cases involved resident abuse or neglect, though 54 criminal cases and 19 civil cases specifically involved fraud. Personal care attendants accounted for 36% of all fraud convictions during the year. Notably, the 2025 SAI Global/Strategic Management Compliance Benchmark Survey found that encounters with MFCUs were on par with those involving the Department of Justice and the OIG.
For more information on this topic, contact Richard Kusserow ([email protected]).ย
