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Texas leads the way in Medicaid fraud recoveries in 2015

The Lone Star State recovered more than $210 million in 2015, nearly four times as much as New York

They say you shouldn't mess with Texas. Those submitting fraudulent claims to the state's Medicaid program should heed that advice.

According to new Medicaid Fraud Control Unit (MFCU) statistics and an interactive map released by the Office of Inspector General, the Texas MFCU netted more than $210 million in fraud recoveries in 2015, almost all of which came from criminal investigations. Texas had fewer convictions than states such as California, Ohio and New York, but brought in significantly more money. New York, which had the second-highest recovery amount, brought in a little more than $63 million.

Texas' recovery rate is particularly impressive given the state's tumultuous history with Medicaid fraud control. In 2013, Texas officials set out to collect $1 billion in Medicaid fraud recoveries, but fell woefully short.

Texas outpaced every other state despite receiving far less in MFCU grant funding. The state received $17.6 million in 2015, nearly half of California's $31.2 million in federal funding, and much less than the $47.3 million provided to New York.

Following Texas, the MFCUs with the highest recovery amount were as follows:

  • New York - $63.3 million
  • California - $57.9 million
  • Florida - $57.6 million
  • Tennessee - $39.9 million
  • Wisconsin - $33.5 million

California had by far the most in "global" civil recoveries ($29.7 million) that resulted from a settlement or judgement involving the Department of Justice and a group of MFCUs.

Last year, New York outpaced all other MFCUs by more than $100 million in recoveries, but states like Louisiana managed significant recoveries with a much less in grant expenditures and a smaller staff. Medicaid fraud continues to be a top concern for government watchdog agencies. In June, Seto Bagdoyan, director of forensic audits and investigative service at the Government Accountability Office testified before the House Subcommittee on Oversight and Investigations that states needed to do more to prevent concurrent payments and payments to deceased beneficiaries.

To learn more:
- here's the MFCU statistics
- see the OIG's interactive map

Related Articles:
GAO to Congress: CMS needs to do more to prevent Medicaid fraud
GAO adds VA to list of programs at high risk of fraud, waste and abuse
Texas Medicaid fraud investigators aimed at $1 billion, fell way short
Auditors: Texas must ramp up Medicaid anti-fraud efforts