The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs) (OEI-06-15-00010, April 2015). Although the MFCUs reported another strong year in civil recoveries, criminal recoveries were significantly lower than last year, when the MFCUs reported the largest monetary criminal recovery in U.S. history, resulting from a joint state-federal investigation of a pharmaceutical manufacturer for unlawful promotion of a prescription drug. The Report notes two areas of concern (discussed below):The inadequate implementation of the Affordable Care Act’s “credible allegation of fraud” payment suspension authority; andThe continuing lack of referrals for state Medicaid managed care fraud investigations.
Source: The Medicaid Fraud Control Units: Fiscal Year 2014 Report – Lexology