February 2007 Newsletter
The Fight Against Medicaid Fraud
The U.S. Congress has given the States the opportunity to work with the Federal Government in the crusade against Medicaid fraud. Specifically, under Section 1909(b) of the Social Security Act (Act), 42 U.S.C.§ 1396h(b), as enacted by Section 6031 of the Deficit Reduction Act (DRA) of 2005, the Federal Government will pay the States an increased share of the recovered funds. As of Jan. 1, 2007, States with laws meeting the DRA requirements qualify for an additional 10 percent share of any Medicaid funds recovered from providers or suppliers.
In order for a State to qualify for the incentive, the State must have in effect a law that meets the following requirements:
1. Liability for False or Fraudulent Claims – 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.
2. Qui Tam Provisions – 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.
3. Seal Provisions – Contain a requirement for filing an action under seal for 60 days with review by the State Attorney General.
4. Civil Penalty Provisions – Contain a civil penalty that is not less than the amount of the civil penalty authorized under the FCA.
Of the 10 states that have submitted their false claims law for review with the Office of Inspector General, only Illinois, Massachusetts, and Tennessee have met all four requirements. The OIG has added a page to its Web site on the State False Claims Acts.