Medicaid Fraud Control Units Annual Report: FY 2025

HHS OIG Reports & Publications

Published March 18th, 2026

Detected March 20th, 2026

Summary

The HHS OIG has released its annual report for Medicaid Fraud Control Units (MFCUs) for Fiscal Year 2025. The report details nearly $2 billion in combined criminal and civil recoveries, 1,185 convictions, and 900 exclusions from federal health care programs. It highlights trends in fraud and patient abuse investigations and prosecutions.

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What changed

The Department of Health and Human Services Office of Inspector General (OIG) has issued its annual report for Medicaid Fraud Control Units (MFCUs) for Fiscal Year 2025. The report indicates that MFCUs recovered nearly $2 billion in combined criminal ($1.3 billion) and civil ($706 million) cases, achieving a return of $4.64 for every dollar spent. MFCUs reported 1,185 convictions (856 for fraud, 329 for patient abuse or neglect) and 900 exclusions of individuals and entities from federal health care programs. Pharmaceutical manufacturers were the most frequent targets of civil settlements and judgments, while personal care services attendants were most frequently convicted of fraud.

This report serves as an informational update on the activities and outcomes of State MFCUs. While it does not impose new obligations, compliance officers should review the findings, particularly regarding fraud trends involving personal care services and patient abuse convictions related to nurses and nurse's aides. The report also identifies beneficial practices that may inform internal compliance program enhancements. No specific compliance deadline or action is mandated by this report, but it highlights areas of significant enforcement activity within the Medicaid program.

Source document (simplified)

Medicaid Fraud Control Units Annual Report: Fiscal Year 2025

Issued on

03/18/2026

| Posted on

03/20/2026

| Report number: OEI-09-26-00140

Report Materials

Why OIG Did This Review

The Department of Health and Human Services Office of Inspector General (OIG) is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU).
This MFCU fiscal year (FY) 2025 annual report highlights case outcomes and other data trends related to investigations and prosecutions that the 53 MFCUs conducted.
The report’s webpage also identifies beneficial practices from prior OIG onsite reports that may be useful to other MFCUs. ## What OIG Found

MFCUs recovered $4.64 for every dollar spent by States and the Federal Government. Combined recoveries from criminal and civil cases totaled almost $2 billion for FY 2025. Criminal recoveries from convictions totaled $1.3 billion and civil recoveries totaled $706 million. MFCUs also reported 674 civil settlements and judgments for FY 2025. Pharmaceutical manufacturers accounted for more civil settlements and judgments than any other provider type. For FY 2025, MFCUs reported 1,185 convictions. MFCU cases resulted in 856 convictions for fraud and 329 convictions for patient abuse or neglect. Significantly more convictions for fraud involved personal care services attendants than any other provider type. The categories of nurse’s aide and nurse had the highest numbers of convictions for patient abuse or neglect. MFCU convictions led to OIG exclusions of 900 individuals and entities from Federal health care programs, broadening the impact of MFCU convictions. For FY 2025, MFCUs reported receiving a total of 5,991 fraud referrals from managed care entities.

Additional Information

The Statistical Chart and data about Case Outcomes and Open Cases can be sorted and filtered. To do this, click on the links below to download the Excel file, then save a copy locally.

To work with the spreadsheets, go to the Review tab and select Unprotect Sheet.