Civil recoveries paid from fraud and abuse cases under Medicaid 2012-2023

Civil recoveries from Medicaid fraud and patient abuse cases amounted to one billion U.S. dollars in 2023, the highest amount reported in the past four years. Medicaid Fraud Control Units (MFCUs) had recovered 2.6 billion U.S. dollars from civil cases in 2012, highest in the provided time interval.

Settlements reached with pharmaceutical companies

MFCUs were responsible for 436 civil settlements and judgments in 2023, around 49 of which involved pharmaceutical manufacturers. One particular civil case involved a national healthcare company that agreed to pay a total of 215 million U.S. dollars to resolve overcharging and falsely reporting higher prescription drug cost. MFCUs were also involved in a number of criminal prosecutions that resulted in 1,143 convictions for fraud and patient abuse.

What are global cases and settlements?

In 2023, nearly 80 percent of the 1.1 billion U.S. dollars in civil recoveries came from non global civil cases. Non-global civil cases are not coordinated by the National Association of Medicaid Fraud Control Units, it involves the MFCUs working either independently or with the assistance of other law enforcement partners, such as county sheriffs’ offices. The remaining 246 million U.S. dollars was derived from global civil cases, it involve the efforts of the federal government and multiple state MFCUs, working together in a plan coordinated by the National Association of Medicaid Fraud Control Units.