The collected data were analyzed and summarized in a national report put together by a professional team that was part of the NAMFCU Patient Abuse Working Group. Results revealed physical, sexual, and emotional abuse; neglect and mistreatment; and financial exploitation. Perpetrators of physical abuse in health care facilities were usually those responsible for the care and well-being of the elder residents and included certified nursing assistants, nurses, and other direct care personnel. Nearly every State Medicaid Fraud Control Unit has also investigated and prosecuted cases of sexual abuse. These units have also had extensive experience in prosecuting cases of emotional abuse. Neglect and mistreatment prosecutions are becoming more prevalent as well. Financial exploitation in institutional settings is one of the fastest growing categories of crimes against elderly and vulnerable individuals. Medicaid discrimination and patient dumping also occur. Investigations of all these forms of crimes present challenges; victims are often unable or unwilling to provide the information necessary for prosecution, and the crimes often have no other witnesses. Creative and diverse initiatives established by State Medicaid Fraud Control Units have focused on legislation and training. Many units regularly take part in interagency task forces and working groups to address the problems; efforts also include undercover operations. A national initiative should include training of State and local judiciaries, higher priority in enforcement on these issues, and other crucial elements. Tables