Since Washington implemented the Medicaid Fraud False Claims Act in 2012, the state has obtained 28 percent more in annual fraud recoveries, according to a preliminary report released last week by the state's Joint Legislative Audit and Review Committee (JLARC). The added recovery dollars make a convincing case for legislatures to renew the law before it expires in 2016.
Washington's law authorizes the attorney general to investigate civil fraud cases, participate in federal whistleblower cases involving Washington providers, and assess penalties up to three times the amount of any fraudulently obtained payments. Since 2012, the attorney general's office has investigated 29 in-state civil cases and has been involved with 57 national cases. State auditors indicated that Washington recovered nearly three dollars for every dollar spent thanks to the law.
Additionally, Washington has reached multi-million dollar settlements in fraud cases thanks to a provision of the law that permits the state to intervene in civil fraud complaints. Allowing the current law to expire would also prevent state prosecutors from actively participating in federal whistleblower investigations. Since Washington's law aligns with the federal FCA, state prosecutors get early notice from the feds when a case is filed and a ten percent increase in any recoveries.
"Having state law include qui tam provisions is a central requirement for obtaining federal approval of a state FCA," the report stated. "If Washington terminates the qui tam provision of its FCA, the state would no longer be eligible for either incentive."
Federal False Claims Act (FCA) cases reached an all-time high last year, with the government recovering $5.7 billion under the FCA, $2 billion of which was attributed to claims against federal healthcare programs. Several reports released at the beginning of the year expect that trend to continue.
Fraud whistleblowers have taken on a greater role in these cases thanks to provisions of the FCA, and state and government investigators have showed a willingness to intervene in civil cases. This trend has led many providers to place more focus on corporate compliance policies.
- here's the JLARC report