In 2023, the criminal cases opened by Medicaid Fraud Control Units (MFCUs) resulted in 814 convictions for fraud. PCS (personal care services) attendants and agencies accounted for 279 fraud convictions, which was significantly more than any other provider type. Overall fraud convictions in 2023 were lower than previous year.
Total criminal convictions increase
MFCUs investigate and prosecute Medicaid provider fraud, but also patient abuse or neglect in nursing homes and care facilities. Convictions involving personal care service assistants accounted for nearly a quarter of all the convictions for abuse or neglect in 2020. Overall, the criminal cases opened by MFCUs resulted in 1,143 convictions in 2023, which was lower than the previous year.
Who is eligible for Medicaid?
Medicaid is a health care program that helps eligible groups of people obtain health insurance. The plan primarily serves low-income groups, including children, parents, and pregnant women. Historically, low-income adults without children were excluded from the program. However, the Affordable Care Act – signed into law by President Obama in 2010 – created the opportunity for states to expand their Medicaid programs to cover nearly all low-income adults under the age of 65.
Provider types with the highest number of convictions for fraud 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 fraud under Medicaid in FY 2023 [Graph]. In Statista. Retrieved December 21, 2024, from https://www.statista.com/statistics/716048/provider-types-with-highest-number-of-convictions-for-medicaid-fraud/
US Department of Health and Human Services, und Office of Inspector General. "Provider types with the highest number of convictions for fraud under Medicaid in FY 2023." Chart. March 14, 2024. Statista. Accessed December 21, 2024. https://www.statista.com/statistics/716048/provider-types-with-highest-number-of-convictions-for-medicaid-fraud/
US Department of Health and Human Services, Office of Inspector General. (2024). Provider types with the highest number of convictions for fraud under Medicaid in FY 2023. Statista. Statista Inc.. Accessed: December 21, 2024. https://www.statista.com/statistics/716048/provider-types-with-highest-number-of-convictions-for-medicaid-fraud/
US Department of Health and Human Services, and Office of Inspector General. "Provider Types with The Highest Number of Convictions for Fraud under Medicaid in Fy 2023." Statista, Statista Inc., 14 Mar 2024, https://www.statista.com/statistics/716048/provider-types-with-highest-number-of-convictions-for-medicaid-fraud/
US Department of Health and Human Services & Office of Inspector General, Provider types with the highest number of convictions for fraud under Medicaid in FY 2023 Statista, https://www.statista.com/statistics/716048/provider-types-with-highest-number-of-convictions-for-medicaid-fraud/ (last visited December 21, 2024)
Provider types with the highest number of convictions for fraud 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/statistics/716048/provider-types-with-highest-number-of-convictions-for-medicaid-fraud/
