OLYMPIA — Attorney General Bob Ferguson’s agency-request bills to combat Medicaid provider fraud by reauthorizing the state’s highly effective Medicaid Fraud False Claims Act (FCA) today unanimously passed the Senate, and passed the House 88 to 8.
Unscrupulous medical providers seek to profit from the state’s Medicaid program — performing unneeded tests, charging for services not provided, and otherwise defrauding and abusing the Medicaid system.
One of the state’ s most effective tools to combat Medicaid fraud is the Medicaid Fraud False Claims Act (FCA), which authorizes the Attorney General to bring civil cases against fraudulent providers to recover Medicaid funds.
Without action from the Legislature, the current act will expire June 30, 2016.
“Medicaid fraudsters steal taxpayer funds and line their pockets with dollars means for health care,” Ferguson said. “The Medicaid False Claims Act has brought enormous benefit to our state by giving my office a powerful tool to hold fraudsters accountable.”
House Bill 1067 is sponsored by Rep. Laurie Jinkins, D—Tacoma.
"There's been a lot of talk about accountability this session," Jinkins said. "This bill will ensure that patients are getting the care they need and that the government investments in patient care are being used effectively and efficiently. Since we first enacted this, we've had a 3–1 return on investment. That's what accountability looks like."
Senate Bill 6156 is sponsored by Sen. Ann Rivers, R—La Center.
“This legislation represents the kind of common-sense measures that taxpayers wish lawmakers would champion more often” said Rivers. “I am honored to be part of ensuring that this cost-savings and consumer-protection act remains strong.”
In December 2015, the Joint Legislative Audit Review Committee (JLARC) unanimously approved the final version of an independent audit report encouraging the Legislature to renew the FCA.
The Medicaid Fraud False Claims Act Sunset Review notes that the Attorney General’s use of the FCA has been highly effective in the three years since its original passage. Since the act’s passage, civil fraud recoveries have increased 28 percent, and the state has recovered $3 for every $1 invested in enforcement under the act.
Since 2012, the Attorney General’s Office (AGO) has recovered $6.1 million that it otherwise would not have been able to without its authority under the FCA.
The report highlights that the FCA allows the state to pursue additional fraud cases through civil actions. Without it, the AGO’s primary tool to fight Medicaid fraud would be criminal prosecutions, which require a higher burden of proof and do not afford the extraordinary damages and penalty provisions of the FCA.
If the FCA is not renewed, Washington could lose significant federal dollars. The federal government provides a $3-to-$1 match for all state moneys provided to the AGO to enforce the False Claims Act.
The state would also lose its full partnership with the National Medicaid Fraud Control Unit, reducing its ability to be fully represented in large, national Medicaid fraud cases. Whistleblower protections provided by the FCA would also disappear.
The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 27 divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Attorney General Bob Ferguson is working hard to protect consumers and seniors against fraud, keep our communities safe, protect our environment and stand up for our veterans. Visit www.atg.wa.gov to learn more.
Alison Dempsey-Hall, Deputy Communications Director