In its latest Medicaid Integrity Program Report, the HHS Office of Inspector General (OIG) outlines Medicaid program integrity activities for FY 2011, including Medicaid-related audits and evaluations and Medicaid-related legal and investigative outcomes.

Funding was employed in 2011 to oversee the integrity of Medicaid activity from the Health Care Fraud and Abuse Control program, the Medicaid Integrity Program, and the American Recovery and Reinvestment Act of 2009. Reported abuses, problems, and deficiencies during the year include prescription drug pricing reviews, manufacturers’ rebates for Medicaid prescription drugs, manufacturers’ rebates for Medicaid compared to Medicare Part D, state claims for federal reimbursement, other payment related reviews, and states’ program management and oversight.

Detailed in the report include the following Medicaid-related legal and investigative outcomes:

  • Education and outreach, including the introduction of the Roadmap for New Physicians.
  • Criminal and civil enforcement including: prescription drugs, pharmacies, and manufacturers; hospitals; clinics; home health services; skilled nursing facilities; and transportation fraud.

OIG oversees and distributes funding under a delegation from the Secretary supporting the investigation and prosecution of Medicaid provider and patient fraud. This funding is given to 50 Medicaid Fraud Control Units (MFCUs), and the report summarizes six examples of outcomes and cases jointly investigated by MFCUs and OIG.

To read or download the full report, click here (PDF).