Home health care aides notched the highest percentage of criminal convictions in cases brought by State Medicaid Fraud Control Units last year, most commonly involving fraud.
Medicaid’s fraud units recovered nearly $2.5 billion in criminal and civil investigations in fiscal year 2013, according to the Annual Report released by the Department of Health and Human Services Office of the Inspector General. Of that, nearly $969 million was related to criminal investigations, with the remainder from civil cases.
Home health care aides accounted for more than a quarter (26%) of all criminal convictions, along with other medical support (7%) and physicians (7%), among other provider types.
Often, the aides were convicted for claiming to have rendered services that were not actually provided to beneficiaries, notes the OIG in the report.
Nearly three-quarters (74%) of criminal convictions in 2013 were for fraud, with patient abuse and neglect accounting for the remaining 26%. Medicaid fraud cases include conspiracy to commit health care fraud, health care fraud, submitting false statements regarding health care or health care reimbursements, grand larceny, and anti-kickback violations.
Home health care agencies accounted for 5% of civil settlements and judgments, an area dominated by pharmaceutical manufacturing, from which MFCUs obtained 62% of civil settlements and judgments.
Access the fiscal year 2013 Annual Report.
Written by Alyssa Gerace