According to the report, Medicaid provides coverage to 1.75 million residents of Washington state, including low-income people and people with disabilities. Medicaid fraud occurs when a healthcare provider knowingly submits claims for payments that the provider is not eligible for, such as billing for goods or services that were not provided, or were of a lower quality or otherwise misrepresented; knowingly making false statements; or knowingly concealing material facts.
Under Washington’s Medicaid Fraud False Claims Act, the office of Washington’s Attorney General was able to pursue cases of Medicaid fraud that it was previously unable to pursue do to lack of authority. According to the report, the Attorney General has investigated 29 in-state cases of Medicaid fraud under the Medicaid Fraud False Claims Act. Furthermore, the total fraud recoveries increased from $69.2 million to $75.6 million.
In addition to the government recovering funds, individual whistleblowers that bring cases forward may be eligible to share in a portion of the money recovered. In some cases, individuals can also file civil qui tam cases. Under Washington’s Medicaid Fraud False Claims Act, three qui tam cases have reportedly been filed, with one resulting in the relator - the person who filed the lawsuit - receiving $292,000.
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As a result of the increased recoveries, the Legislative Auditor recommended Washington reauthorize the Medicaid Fraud False Claims Act.
Federally, individuals who suspect a person or organization is committing healthcare fraud can bring forward claims against those responsible. Whistleblowers are protected by state and/or federal law and may be eligible to receive a portion of any money recovered.
One such recently settled lawsuit reported resulted in two whistleblowers sharing in a $1.1 million award.