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Alabama Attorney General lacks serious tools to fight Medicaid fraud

Bill Britt

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By Bill Britt
Alabama Political Reporter

Yearly, State lawmakers struggle to feed the beast know as Medicaid, and every year they ignore Medicaid fraud legislation that would bring tens of millions back into our State coffers annually.

By denying the State’s Attorney General’s Office the tools to prosecute Medicaid fraud, the State is losing millions in recoverable funds while allowing perpetrators to remain free to continue to defraud the system.

By passing a False Claims Act, along with qui tam, a door would open for real Medicaid fraud prosecution. A False Claim Act imposes liability on persons and companies who defraud government programs. Qui tam is a term used for rewarding a whistleblower who exposes fraud on the government for which they receive a 10 percent share of the recovery. Currently, 35 states have a False Claims Act with qui tam, but not Alabama.

Monies captured under a False Claims Act with qui tam where qui tam meets Debt Reduction Act provisions would result in an HHS award of 10 percent bonus of all monies recovered by the State.

“Fraud and abuse in Medicaid cost states billions of dollars every year, diverting funds that could otherwise be used for legitimate health care services,” are the findings of the National Conference of State Legislature (NCSL). It also found that “As states look for innovative ways to contain burgeoning Medicaid costs, fighting fraud and abuse offers one approach that everyone can support.”

For the Fiscal year 2016, Alabama’s Attorney General’s Medicaid Fraud Control Unit opened 52 cases and recovered $16,921,362.

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State’s MFCUs are funded jointly by its State and the Federal government. Each Unit receives Federal financial participation equivalent to 75 percent of its total expenditures, with State funds contributing the remaining 25 percent.

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According to data available from the Federal MFCU report for the Fiscal year 2015, Alabama opened 39 investigations, indicted 8 and convicted five for criminal fraud and settled five civilly recovering $5,495,672,054.

In comparison, Georgia opened 445 fraud cases, which resulted in 75 criminal convictions and 25 civil settlements recovered $10,245,084,441 and in 2014 recovered $48.7 million.

It is important to note that not every case that is opened in a year is completed in the same year, so many of the opened cases are finalized in subsequent years.

Mississippi opened 85 cases in 2015, with 15 criminal convictions and 9 settlements and recovered $5,495,672,054 in 2014 the state realized $17.3 million in recovered funds.

Florida recovered $21,909,678,011 in 2015 and $91.8 million in 2014 and Tennessee in the same period successfully prosecuted and recovered $62.3 million.

Why such large disparities in results?

State laws.

For years the Alabama legislature has refused to pass a False Claims Act of any kind, while Florida, Georgia, and Tennessee have and this is why those states are recouping much larger amounts of money.

Why does Alabama not even have a law at all?

Lobbyists.

Associations spend millions on lobbying to protect providers, hospitals, clinics and others who collect Medicaid payments from false claim prosecution.

During the 2016 Legislative Session, a bill was put forward to give the Attorney General’s Office the necessary laws to enable its Medicaid Fraud to do a better job at hunting down and prosecuting Medicaid Fraud. The bill died before serious consideration was given to its meaning.

A bill has yet to be offered for the 2017 Session.

 

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