Each year, the Department of Health and Human Services Office of Inspector General’s Office of Evaluations and Inspections reviews states’ Medicaid Fraud Control Units (MFCUs). The latest report provides information on convictions, recoveries, settlements, and additional metrics used in combatting fraud.

This year’s report found that MFCUs recovered $4.64 for every combined state and federal dollar spent on their operation. Convictions in personal care attendant services were by far the most common with 326 followed by 63 convictions for fraud in non-residential mental health facilities.

Criminal recoveries rose moderately to $1.3B, though some of these collections account for efforts and investigations that began prior to 2025. There is no additional information about how recoveries from prior years could have been inclusive of multi-year investigations.

Civil judgements and settlements were most prevalent among pharmaceutical manufacturers (121) followed by clinical labs with 95. An example of a civil settlement can include violations of kickback laws.

The report praises managed care companies in sending potential fraud referrals to MFCUs, though over the five year average, the percentage of investigations opened as a subset of total referrals has decreased from about 26% in 2021 to near 19% in 2025.

The report underscores that financial investment in MFCUs pays dividends in recoveries and convictions. The existing process works without imposing additional policy and administrative burdens on quality providers. View the report here.