July 14, 2020

Volume X, Number 196

July 14, 2020

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July 13, 2020

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Bipartisan Group of PA Lawmakers Introduce Bills to Combat Medicaid Fraud

A bipartisan group of Pennsylvania lawmakers will introduce six new laws designed to combat Medicaid fraud in the state. The bills, which lawmakers plan to submit in the House and the Senate, come after a Grand Jury Report detailed misspending and fraud in Pennsylvania’s Medicaid program.

According to the report, certain loopholes in the Medicaid program have left it vulnerable to tens of thousands of dollars in fraud. In the fiscal year 2017, state and federal agencies investigated and prosecuted fraudsters recovering a total of $11.6 million.

Pennsylvania Attorney General Josh Shapiro said the federal government estimates that fraud and improper payments account for $3 billion lost in Pennsylvania every year.

The bills introduced by the lawmakers will follow the recommendations made by the Grand Jury.

One proposal for the new PA law would implement a state version of the False Claims Act, allowing Pennsylvania to receive 10% of the funds back of false claims made against Medicaid from settlements under the federal law.

Another proposed bill would require agencies to take a look at their programs to determine whether or not they are vulnerable to fraudulent payments.

Whistleblower reward laws such as the federal False Claims Act have proven to be highly effective in combating fraud associated with the health care industry. In 2019, the Department of Justice recovered over $3 billion in settlements and judgments from False Claims Act cases. Of that $3 billion, $2.1 billion came from actions brought on by qui tam relators under the False Claims Act.

Medicaid fraud can include payments of kickbacks to induce providers to prescribe products or prescriptions, billing for unnecessary procedures or equipment, and upcoding to overcharge for services or products.

Whistleblowers who report Medicaid fraud under the qui tam provisions of the False Claims Act are eligible for monetary rewards. The whistleblower can receive an award of 15-25% percent of the recovery made by the government.

Ben Kostyack also contributed to this article.

Copyright Kohn, Kohn & Colapinto, LLP 2020. All Rights Reserved.National Law Review, Volume X, Number 45

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About this Author

Mary Jane Wilmoth KKC  managing partner  whistleblower protection, environmental and nuclear industry whistleblowers, Qui Tam/False Claims whistleblowers.
Managing Partner

Mary Jane Wilmoth is the firm’s managing partner, and works closely with the partners at KKC, specializing in environmental and nuclear whistleblower protection, Qui Tam/False Claims litigation, and labor and employment law. She joined the firm in 1992, and works on cases and hearings that involve complex nuclear and environmental regulations. In her efforts to assure such safeguards are upheld in the American workplace, she has helped to strengthen whistleblower rights in licensing and enforcement proceedings with the Nuclear Regulatory Commission. She has also defended whistleblowers at...

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