OIG: State Medicaid Fraud Unit recovers $181M

Tennessee's Medicaid fraud control unit clawed back $181 million in illegal provider payments and obtained more than 100 criminal convictions and civil settlements between the 2009 and 2011 fiscal years, according to a new report by the U.S. Department of Health & Human Services' Office of the Inspector General.

The report concluded that during that time period, the state's fraud unit obtained 96 criminal convictions--52 of which were for healthcare fraud and 15 for theft of patient funds--and settled 22 civil cases.

Moreover it recovered more than $10.2 million as a result of criminal actions, and obtained another $171.4 million through civil actions.

The OIG was critical of the fraud unit in two instances: The unit investigated one case that did not involve Medicaid fraud, and it failed to report to the OIG criminal convictions involving non-healthcare providers.

Meanwhile, federal fraud cases in Tennessee recently encountered a major setback. Last month, a federal appeals court in Nashville threw out convictions involving more than $94 million in Medicare fraud, reported the Tennessean. According to the federal appeals court, the two cases centered on payment issues, not enrollment, and therefore should have been resolved through an administrative process, the article noted.

For more:
- read the report
- read the Tennessean article

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