Renew tool that fights Medicaid fraud

Washington state could soon lose a successful program that in the three years it has operated has uncovered and penalized fraud, returned nearly $3 for every $1 spent in investigating and prosecuting cases and protected the source of medical coverage for 1.75 million residents.

Unless the Legislature votes to reauthorize the Medicaid Fraud False Claims Act, an effective tool used by the state Attorney General’s Office for rooting out Medicaid fraud and encouraging compliance will be shut down by the end of June.

The act, passed in 2012, adds a third avenue for investigating Medicaid fraud, bolstering the efforts by the federal False Claims Act and criminal investigation of the state Attorney General’s Office. Washington is one of 29 states with a False Claims Act.

ADVERTISEMENT
0 seconds of 0 secondsVolume 0%
Press shift question mark to access a list of keyboard shortcuts
00:00
00:00
00:00
 

The 1.75 million state residents who depend on Medicaid include low-income adults, children, pregnant women, elderly adults and those with disabilities. Medicaid is funded jointly by the federal and state governments. Of the $9.6 billion spent in 2014 in Washington, $4 billion was provided by the state.

Medicare and the taxpayers’ interest in limiting waste, fraud and abuse from false claims for medical services, drugs, supplies and equipment, must be protected. The Legislature needs to prevent the False Claims Act from expiring, as recommended by the Legislature’s own Joint Legislative Audit and Review Committee. Bipartisan bills in the House (HB 1067) and Senate (SB 6156) would extend the act until 2021 or later.

JLARC, in its report, found that the act has allowed the state to pursue 29 civil cases of Medicaid fraud that it otherwise would not have had the authority to pursue. Following the act’s creation the state AG’s office added a civil section for Medicaid fraud that includes four attorneys, five investigators, a financial examiner and two paralegals. The federal government funds three-fourths of the program’s expenditures, with the state picking up the other fourth.

In the three years the program has been in effect, the JLARC report found, the act was responsible for $6.1 million in additional fraud recoveries, of which the state recouped $2.8 million. Average annual civil recoveries increased 28 percent compared to the three and a half years prior to the program’s enactment. Recovered funds are reinvested in Medicaid services for state residents.

In calling for the act’s renewal, state Attorney General Bob Ferguson credited the act with revealing instances of fraud and abuse that might have remained concealed without it. In addition to information from the state’s Medicaid program, the AG’s office is able to act on tips from the public, stories in newspapers and the media and from whistle-blowers, called qui tam filings.

Reauthorization of the False Claims Act also must protect provisions for qui tam filings.

When the legislation was first considered in 2012, hospital and medical associations and others said the whistle-blower filings could be abused themselves and result in frivolous lawsuits. The JLARC report found no evidence of that. In the act’s three years, four qui tam cases have been filed: One case, which involved poor quality of care and kickbacks, resulted in a settlement; another was dismissed following a state investigation; and two more are pending.

The act’s three years of cost-effective investigation of fraud and its role in discouraging dishonest medical providers and others from attempting to file false claims have earned its reauthorization by the Legislature.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Opinion

toon
Editorial cartoons for Friday, May 23

A sketchy look at the news of the day.… Continue reading

A visitor takes in the view of Twin Lakes from a second floor unit at Housing Hope’s Twin Lakes Landing II Wednesday, Feb. 22, 2023, in Marysville, Washington. (Ryan Berry / The Herald)
Editorial: Housing Hope’s ‘Stone Soup’ recipe for community

With homelessness growing among seniors, an advocate calls for support of the nonprofit’s projects.

Schwab: Words, numbers mean what Trump and cadre say they mean

It’s best if you 86 past and present; they only keep you from accepting what’s happening around you.

Time for age, term limits for all politicians

I think we’re all getting weary about how old and decrepit our… Continue reading

Fluoridated water best way to ensure dental health

Obviously drinking bleach in any form is not a great proposition, and… Continue reading

What do we need with growth and its problems?

Why do we have to prepare for growth? Stupid question, right? Well… Continue reading

Kristof: Helpful tips from an anti-authoritarian playbook

Don’t underestimate the power of mockery, pointing out corruption and the influence held by one person.

Wildfire smoke builds over Darrington on Friday, Sept. 11, 2020 in Darrington, Wa. (Olivia Vanni / The Herald)
Editorial: Loss of research funds threat to climate resilience

The Trump administration’s end of a grant for climate research threatens solutions communities need.

Sarah Weiser / The Herald
Air Force One touches ground Friday morning at Boeing in Everett.
PHOTO SHOT 02172012
Editorial: There’s no free lunch and no free Air Force One

Qatar’s offer of a 747 to President Trump solves nothing and leaves the nation beholden.

The Washington State Legislature convenes for a joint session for a swearing-in ceremony of statewide elected officials and Governor Bob Ferguson’s inaugural address, March 15, 2025.
Editorial: 4 bills that need a second look by state lawmakers

Even good ideas, such as these four bills, can fail to gain traction in the state Legislature.

toon
Editorial cartoons for Thursday, May 22

A sketchy look at the news of the day.… Continue reading

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.