An Audit Report on Medicaid Fraud Control Activities at the Office of the Attorney General
August 2008
Report Number 08-040
Overall Conclusion
The Office of the Attorney General (Office) investigates criminal and civil complaints of fraud, abuse, and neglect committed by health care providers in the Medicaid program.
The Office's Medicaid Fraud Control Unit (MFCU) is fulfilling its principal responsibilities by investigating and resolving criminal Medicaid fraud, abuse, and neglect complaints. MFCU effectively screens complaints about potential fraud and abuse committed by Medicaid providers. For fiscal year 2007, MFCU reported it:
- Concluded 528 investigations.
- Referred 413 cases for prosecution.
- Identified $58 million in overpayments made to Medicaid providers.
The Office's Civil Medicaid Fraud Division (CMF) settled 24 cases between September 1, 2005, and May 5, 2008, for a total of $131.2 million, according to auditors' calculations. CMF received additional appropriations for fiscal year 2008 to address the increasing number of lawsuits filed by private citizens, and it has developed a plan for and made progress in reducing the number of pending cases.
Although MFCU is investigating and resolving criminal Medicaid fraud, abuse, and neglect complaints, it should improve its processes for recording certain information about the complaints in the Office's automated Case Management System so that the Office can analyze the efficiency and effectiveness of MFCU's investigative processes.
Contact the SAO about this report.
Download the Acrobat version of this report. (.pdf)
If you prefer an HTML version, follow this link to an Adobe site which converts PDF files to HTML.