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…
This remains the most prevalent form of financial crime globally. It targets the direct access points to your money: your cards and your bank accounts.
- Skimming: Criminals use small devices called “skimmers” placed over ATM or point-of-sale card slots to capture the data from your card’s magnetic strip.
- Card-Not-Present (CNP) Fraud: This occurs during online shopping where a physical card isn’t required. Thieves use stolen card numbers, expiry dates, and CVV codes to make unauthorized purchases.
- Account Takeover (ATO): A hacker gains access to your online banking credentials (often through malware or phishing) and changes the contact details or passwords, locking you out while they drain your funds.