The criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 329 convictions for patient abuse or neglect in nursing homes and care facilities in 2023 – the cases are rising from the 2020 level. Of these, 108 convictions involved nurses or nurse's aides.
Most criminal convictions are for fraud
MFCUs investigate and prosecute fraud and patient abuse or neglect by health care providers in the administration of the Medicaid program. Overall, there were 1,143 criminal convictions in 2023, which was lower than previous years. Fraud convictions also decreased in 2023, and 279 of those cases involved PCS (personal care services) attendants and agencies.
How do criminal cases work?
The journey that leads to a criminal conviction starts with MFCUs being made aware of a possible case – a referral may come from an external source such as a state Medicaid agency or a member of the public. The case is reviewed for validity, and if the claims are substantiated, the MFCUs will gather further evidence and conduct an investigation. As prosecutors, the MFCUs may file a criminal complaint that could lead to a conviction. MFCUs have proven to be very successful and recovered more than 272 million U.S. dollars from criminal convictions in 2023.
Provider types with the highest number of convictions for abuse or neglect under Medicaid in FY 2023
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US Department of Health and Human Services, & Office of Inspector General. (March 14, 2024). Provider types with the highest number of convictions for abuse or neglect under Medicaid in FY 2023 [Graph]. In Statista. Retrieved November 10, 2024, from https://www-statista-com.ezproxy.canberra.edu.au/statistics/716062/provider-types-with-highest-number-of-convictions-for-medicaid-abuse/
US Department of Health and Human Services, und Office of Inspector General. "Provider types with the highest number of convictions for abuse or neglect under Medicaid in FY 2023." Chart. March 14, 2024. Statista. Accessed November 10, 2024. https://www-statista-com.ezproxy.canberra.edu.au/statistics/716062/provider-types-with-highest-number-of-convictions-for-medicaid-abuse/
US Department of Health and Human Services, Office of Inspector General. (2024). Provider types with the highest number of convictions for abuse or neglect under Medicaid in FY 2023. Statista. Statista Inc.. Accessed: November 10, 2024. https://www-statista-com.ezproxy.canberra.edu.au/statistics/716062/provider-types-with-highest-number-of-convictions-for-medicaid-abuse/
US Department of Health and Human Services, and Office of Inspector General. "Provider Types with The Highest Number of Convictions for Abuse or Neglect under Medicaid in Fy 2023." Statista, Statista Inc., 14 Mar 2024, https://www-statista-com.ezproxy.canberra.edu.au/statistics/716062/provider-types-with-highest-number-of-convictions-for-medicaid-abuse/
US Department of Health and Human Services & Office of Inspector General, Provider types with the highest number of convictions for abuse or neglect under Medicaid in FY 2023 Statista, https://www-statista-com.ezproxy.canberra.edu.au/statistics/716062/provider-types-with-highest-number-of-convictions-for-medicaid-abuse/ (last visited November 10, 2024)
Provider types with the highest number of convictions for abuse or neglect under Medicaid in FY 2023 [Graph], US Department of Health and Human Services, & Office of Inspector General, March 14, 2024. [Online]. Available: https://www-statista-com.ezproxy.canberra.edu.au/statistics/716062/provider-types-with-highest-number-of-convictions-for-medicaid-abuse/
