Medicaid Fraud Control Units were started a year after the 1976 GAO Fraud in Government study
showed Medicaid and Medicare had fraud rates of 60%, Medicaid Fraud Control Units were initiated.
At the same time, fraud in defense was “front page news.” However, only 40%. Congress passed the
Medicare and Medicaid Anti-Fraud and Abuse Act, requiring states with Medicaid Fraud Control Units
were funded with federal grants.
Every state except North Dakota had a Medicaid Fraud Control Unit. One year later the National
Association of Medicaid Fraud Control Units began. (neither Inspectors General offices nor state
Medicaid Fraud Control Units wanted to know anything about fraud.) The federal government provides
funds and 75% grants to fund 2,000 MFCU employees, consisting of mostly office staff, not auditors
and investigators and very few attorneys.
Their recoveries are often connected to Medicare fraud. However, Medicaid only recoveries are not
included in Justice Department fraud statistics even though they mostly recover Federal funds. The
original 50/50 “split” has become an average 57% of federal funds.
Medicaid cases are reported by TAF.org and Medicaid Fraud Control Units, reported separately in
annual summaries to HHS Inspector General. https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp
They are better for states with laws. http://www.ncsl.org/research/health/clarifying-requirements-for-a-state-false-claims-a.aspx
There is no way to determine exactly what was “stolen from taxpayers”, as many thousands of cases
filed were not investigated or reported. They are known only by whistleblowers and relators stifled
by government agencies stopping fraud enforcement agents from investigating cases and collecting
the double and triple damages stolen from taxpayers,
Healthcare is still the most fraud ridden field, but fraud and low recoveries is not limited to any
one agency. For example, a recent case settled in November 2016 against Education Management
Corporation is illustrative of the “Fraud Problem.” The amounts defrauded by EDMC were reported as
$11 billion, while the settlement was only $95.5 million [1%].
This was shortly after Sally Quinn (in charge of these cases), said they would start jailing people
in cases like these. For the last 30 years, in 11thousands qui tam cases; not only has no one gone
to jail, no defendant has gone to court either.