Why Washington’s Medicaid Fraud False Claims Act Must be Renewed
By: Shayne Stevenson
Combating the growing avalanche of health care fraud in our state and across the country requires using the right law enforcement tools. One of the most useful tools in the battle against health care fraud in this state is the Washington Medicaid False Claims Act. Statutes like it at the federal level and currently in over 30 states and cities have been successful for decades and have operated to save literally tens of billions of taxpayer dollars.
These laws succeed because they incentivize and reward whistleblowers who bring original information about health care fraud to authorities.
For several years, the largest aggregate recoveries under the False Claims Act have been for actions challenging Medicare and Medicaid fraud. Several billion dollars have been recovered in just the past five years against leading pharmaceutical companies, device manufacturers and various medical providers for ever-inventive schemes of fraud.
Fraud on the multi-billion dollar Medicare and Medicaid programs comes in a variety of forms. These cases involve, among other things: schemes that inflate medical bills by claiming patients require procedures or more expensive procedures than actually necessary; pricing fraud; unlawful billing for procedures never performed or supplies never ordered; kickbacks to physicians, physician practices, or hospitals in violation of the Anti-Kickback Statute; off-label promotion of drugs and medical devices; violations of the Stark law.
Washington’s Medicaid Fraud False Claims Act has returned nearly $3 for every $1 spent in investigating and prosecuting healthcare fraud cases just in the last few years since it was adopted.
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