Tuesday, September 21, 2021
Sept. 21, 2021

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In Our View: Fraud Law Effective Tool

Legislature demonstrated responsible leadership with Medicaid bill’s renewal

The Columbian
Published:

Easily lost amid the high-profile wrangling over the formation of a supplemental budget and an overtime legislative session, lawmakers last month approved a bill that represents government at its most responsible.

The Medicaid Fraud False Claims Act, which was scheduled to sunset on June 30, was renewed under Senate Bill 6156, sponsored by Sen. Ann Rivers, R-La Center. The fact that the legislation passed the Senate by a 48-0 vote and the House by a count of 96-1 reflects the effectiveness of the law since it initially passed in 2012.

The law gives the state Office of the Attorney General the authority to pursue Medicaid fraud in civil court rather than only criminal court. Attorney General Bob Ferguson says it has helped result in judgments of more than $6 million in fraudulent charges since it was enacted — a return of about 3-to-1 when compared with the expense of the program. In the past, Ferguson has told The Columbian’s Editorial Board: “This is a robust statute that gives us power to go after fraudsters where it hurts their pocketbook.” He added: “Medicaid funds are a precious resource in our state. If you knowingly commit Medicaid fraud, my office will hold you accountable.”

In one recent example, Ferguson’s office pursued penalties against the owner of Wheelchairs Plus. A court found that the company would purchase used wheelchair parts, cobble them together, sell them to patients as new, and then charge the state’s Medicaid program for the cost for a new chair. The owner of the company has been ordered to pay the state $2.7 million for this fraud. “It is deplorable when fraudsters take advantage of a vulnerable population for financial gain,” Ferguson said.

That, as much as anything, points out the importance of the Medicaid fraud law. About 1.75 million Washington residents rely upon Medicaid to help pay their medical expenses, and those citizens typically fall into the category of the state’s most vulnerable. Low-income adults, the elderly, and those with disabilities often benefit from a program that is administered jointly by the federal government and the state. In Washington in 2014, $9.6 billion worth of medical coverage was billed to Medicaid, with $4 billion of that coming from the state. The breadth of the program leaves it vulnerable to fraud, a fact that calls for diligence and a series of useful tools to be at the disposal of state investigators.

While the fraud legislation is designed to provide some protection for taxpayers, the most important fact is that it is effective. Last year, a Joint Legislative Audit and Review Committee examined the program, finding that the state had pursued 29 cases under the law, and that of $6.1 million in judgments about $2.8 million had been recovered. Meanwhile, the state pays for one-quarter of the program while the rest comes from the federal government, and Ferguson’s office has added an enforcement arm including four lawyers and five investigators. The audit also found that no frivolous lawsuits had been brought forth under the program, which was a concern for some health providers because the law encourages whistleblowers to come forward when they have knowledge of fraud.

In many regards, the Medicaid Fraud Claims Act represents what citizens should demand from their government. It protects taxpayer dollars in a cost-efficient manner; it protects vulnerable citizens; and its effectiveness can be accurately measured. Lawmakers were wise to renew an important tool for the attorney general’s office.

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