03/26/2026

OIG Releases 2025 Snapshot on Medicaid Fraud Control Unit Performance

The U.S. Department of Health and Human Services Office of Inspector General (OIG) has released its latest annual data snapshot on state Medicaid Fraud Control Units (MFCUs), highlighting key trends in convictions, recoveries, and enforcement activity.

According to the report, MFCUs continue to deliver strong returns on investment—recovering $4.64 for every combined state and federal dollar spent. Criminal recoveries reached $1.3 billion in 2025, reflecting a modest increase, though some recoveries stem from investigations initiated in prior years.

Personal care attendant services accounted for the highest number of criminal convictions (326), followed by 63 convictions tied to fraud in non-residential mental health facilities. On the civil side, judgments and settlements were most frequently associated with pharmaceutical manufacturers (121 cases) and clinical laboratories (95 cases), often involving violations such as unlawful kickbacks.

The report also highlights the role of managed care organizations in identifying and referring potential fraud cases to MFCUs. While referrals remain strong, the share of referrals resulting in opened investigations has declined over the past five years—from approximately 26% in 2021 to about 19% in 2025.

Overall, the findings reinforce that sustained investment in MFCUs yields meaningful results in both recoveries and convictions. The report suggests that the current framework is effective in addressing fraud without adding unnecessary policy or administrative burden for compliant providers.

View the report here. 

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