Consumer Fraud

WA Audit Advocates Renewal of State Medicaid Whistleblower Law

whistleblower WA Audit Advocates Renewal of State Medicaid Whistleblower LawA whistleblower law passed by Washington state legislators in 2012 to recover much-needed Medicaid funds is working as intended, according to a report by Joint Legislative Audit & Review Committee (JLARC). The legislative auditors conducted the review ahead of the anti-fraud law’s expiration date next year, urging state lawmakers to renew it.

“The Legislative Auditor recommends that the Legislature reauthorize the Medicaid Fraud False Claims Act,” the JLARC reported, adding that the law “allows the state to pursue civil cases against Medicaid fraud that it would lack authority to pursue otherwise.” The committee also said that Medicaid fraud recoveries have increased since the law was passed.

Medicaid is a health care program jointly funded by the federal government and individual states to provide affordable health care to low-income individuals and families. Washington State’s Medicaid program pays nearly $10 billion per year for the medical needs of the state’s low-income citizens.

Unfortunately, Medicaid, like Medicare and other federally funded and subsidized programs, is frequently defrauded by individuals and corporations seeking to increase profits or add money to their bottom line. Medicaid and Medicare fraud takes badly needed health care funds from vulnerable Americans and drives up costs for everyone.

Medicaid fraud is committed when providers submit false claims to the Medicaid program for reimbursement for medical costs, often billing for services not provided, overbilling for services, and other schemes to obtain payment to which they are not legally entitled.

One way Washington combats Medicaid fraud is through civil cases brought by the Attorney General and private individuals acting as whistleblowers under the authority of the state’s Medicaid Fraud False Claims Act (FCA). Washington’s False Claims Act complements state criminal and federal Medicaid Fraud investigations, as whistleblowers provide information and tips that state and federal authorities may otherwise never be able to access.

Washington’s Medicaid Fraud False Claims Act is set to expire on June 30, 2016, unless the legislature votes to reauthorize it.

Source: The Joint Legislative Audit & Review Committee