The Office of the Inspector General (OIG) recently reported that the Medicaid fraud control units (MFCUs) secured 1157 fraud convictions. The MFCU investigates those accused of Medicaid fraud.
What leads to an investigation by an MFCU? The investigations are generally initiated by referrals or complaints made to the organization. Data mining can also provide a means to conduct an investigation.
How did the convictions break down by specialty? Convictions were present in the audiology, nursing, pharmaceutical and psychology professions. Convictions also occurred in the ambulatory service and billing service provider industries.
Of the various medical specialists that faced prosecution, family practitioners ranked the highest. 36 family practitioners were criminally convicted and seven faced civil settlements and judgements. Internal medicine providers came in second, with seven criminal convictions and nine practitioners reaching civil settlements and judgements.
Overall, the agency reports the number of convictions in 2017 were similar to those of previous recent years.
What are the repercussions that come with a conviction? In addition to potential jail time, those convicted of a Medicaid fraud crime can face monetary penalties and the loss of their professional license. Facilities convicted of these crimes can also face the loss of the ability to participate in federally funded health care programs.
The OIG notes that it is a “top priority” to strengthen the effectiveness of the MFCUs throughout the country. As such, these investigations will likely increase. Physicians and other medical practitioners that find themselves the subject of this type of investigation should take action to help preserve their professional interests. An attorney can discuss your options and work to protect your interests.