:: State False Claims Acts Aid In Combating Medicaid Fraud

Similar to the federal False Claims Act, many states have enacted analogous statutes. As enacted by section 6031 of the Deficit Reduction Act of 2005, section 1909 of the Social Security Act (Act) provides a financial incentive for States to enact false claims acts that establish liability to the State for the submission of false or fraudulent claims to the State’s Medicaid program.

To gain the incentive the state laws must:

  • Establish liability to the State for false or fraudulent claims described in the False Claims Act (FCA) with respect to any expenditures related to State Medicaid plans described in section 1903(a) of the Act;
  • Contain provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as those described in the FCA;
  • Contain a requirement for filing an action under seal for 60 days with review by the State Attorney General;
  • Contain a civil penalty that is not less than the amount of the civil penalty authorized under the FCA.

Since the federal government has (growing) funding responsibility for Medicaid, the incentives are designed to share compensation in hopes of a broader enforcement effort.

New Jersey’s statute recently failed to qualify, while Wisconsin’s met the OIG requirements.

States with false claims acts reviewed by the OIG at present:

New Hampshire
New Jersey
New Mexico
New York
Rhode Island

Not all statutes have been approved, and changes in the state statutes can result in approval of those previously not meeting the OIG standards. In any event, if Medicaid fraud is suspected, state statutes should be consulted for possible application in conjunction with the federal statute.

More information is available on the OIG website here.