Stopping Medicaid fraud

April 09, 2010

Maryland is on the verge of enacting a state false claims act allowing whistleblowers and the state to target those entities ripping off state health programs. Maryland would be the 26th state to enact such a false claims act.

Overall, false claims acts are an unqualified success in helping to detect fraud and recover money falsely claimed against government programs. False claims acts on the national and state levels have recovered more than $20 billion since 1986.

Opponents have argued that Maryland doesn't need a law and that the federal false claims act would suffice. State action in this area is needed because some false claims are state-specific and do not rise to the level of federal action. Plus, the backlog of cases at the federal level is said to be at least in the hundreds.

Opponents argue that the legislation would open the door to unwanted frivolous actions because whistleblowers would be entitled to a share of the damages. False claims acts are highly complex, and any reward that might occur will likely take years after the case is first brought forward deterring anyone from bringing a frivolous action. Furthermore, the proposal is well crafted in that it creates a relatively high bar to bring only the most egregious cases.

These statutes empower and reward citizens who blow the whistle on government fraud and uncover schemes that likely would go undetected. Without the knowledge and assistance of people on the inside of these corporate schemes, the government has little chance of succeeding in recovering stolen money.

Opponents also argue that passage will harm the economic vitality of Maryland. We have a track record in 25 states to show that is not the case. Saying that businesses would be reluctant to locate in the state if this legislation passes flies in the face of the reality that firms have not fled those 25 states that already have what the General Assembly is now debating.

This is a win-win solution that benefits the state, its taxpayers and employees of health care organizations. It also benefits the citizens whose health depends on the viability of state programs. Given the desire to reduce the cost of health care, we need to use all weapons to target the fraud, and a false claims act will do that.

Howard Goldblatt, Washington

The writer is director of government affairs for the Coalition Against Insurance Fraud.

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