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    Medicaid False Claims Act Review 3

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    Beverly Tran
    The letter determines that Michigan's Medicaid False Claims Act meets the requirements to qualify for a federal incentive under the Deficit Reduction Act. It finds that the amended version of Michigan's law addresses all prior concerns identified by the Office of Inspector General and Department of Justice. Signing the letter would certify that Michigan's false claims law fulfills the conditions to receive an increased federal matching rate for Medicaid fraud recoveries.

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    Medicaid False Claims Act Review 3

    Uploaded by

    Beverly Tran
    128 views3 pages
    The letter determines that Michigan's Medicaid False Claims Act meets the requirements to qualify for a federal incentive under the Deficit Reduction Act. It finds that the amended version of Michigan's law addresses all prior concerns identified by the Office of Inspector General and Department of Justice. Signing the letter would certify that Michigan's false claims law fulfills the conditions to receive an increased federal matching rate for Medicaid fraud recoveries.

    Original Description:

    U.S. Department of Health and Human Services Second Review of Michigan False Claims Act

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    The letter determines that Michigan's Medicaid False Claims Act meets the requirements to qualify for a federal incentive under the Deficit Reduction Act. It finds that the amended version of Michigan's law addresses all prior concerns identified by the Office of Inspector General and Department of Justice. Signing the letter would certify that Michigan's false claims law fulfills the conditions to receive an increased federal matching rate for Medicaid fraud recoveries.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    128 views3 pages

    Medicaid False Claims Act Review 3

    Uploaded by

    Beverly Tran
    The letter determines that Michigan's Medicaid False Claims Act meets the requirements to qualify for a federal incentive under the Deficit Reduction Act. It finds that the amended version of Michigan's law addresses all prior concerns identified by the Office of Inspector General and Department of Justice. Signing the letter would certify that Michigan's false claims law fulfills the conditions to receive an increased federal matching rate for Medicaid fraud recoveries.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    The letter reviews Michigan's Medicaid False Claims Act and determines that it meets the requirements of the Deficit Reduction Act.

    The letter is informing the recipient that based on OIG's review, Michigan's Medicaid False Claims Act meets the requirements to qualify for a financial incentive under the Deficit Reduction Act.

    Massachusetts, Illinois, Tennessee, Virginia, Hawaii, Texas, New York, Nevada, California, Georgia, Indiana, Rhode Island, and Wisconsin have had their false claims acts approved.

    ..

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    DEPARTMENT OF HEALTH & HUMAN SERVICES

    APR 1 5 2009
    Office of Inspector General

    Washington, D.C. 20201

    Wallace T. Hart
    Division Chief, Health Care Fraud Division
    Department of the Attorney General
    P.O. Box 30218
    Lansing, Michigan 48909

    Dear Mr. Hart:

    The Offce ofInspector General (OIG) ofthe U.S. Department of Health and Human Services
    (HHS) has received your request to review the Michigan Medicaid False Claims Act, Mich.
    Compo Laws §§ 400.601 through 400.615, under the requirements of section 6031(b) of the
    Deficit Reduction Act (DRA). Section 6031 of the DRA provides a financial incentive for States
    to enact laws that establish liability to the State for individuals and entities that submit false or
    fraudulent claims to the State Medicaid program. For a State to qualify for this incentive, the
    State law must meet certain requirements enumerated under section 6031 (b) of the DRA, as
    determined by the Inspector General of HHS in consultation with the Department of Justice
    (DOJ). Based on our review of
    the law and consultation with DOJ, we have determined that the
    Michigan Medicaid False Claims Act meets the requirements of section 6031 (b) of the DRA.

    Any amendment to the Michigan Medicaid False Claims Act could affect OIG's determination
    that it meets the requirements of section 6031 (b) of the DRA. Therefore, please notify OIG of
    any amendment to the Michigan Medicaid False Claims Act within 30 days after such
    amendment.

    If you have any questions regarding this review, please contact me or have your staff contact
    Katie Arnholt at (202) 205-3203 or katie.arnholt~oig.hhs.gov.

    ~¿~
    Sincerely,

    Daniel R. Levinson
    Inspector General

    cc: Richard P. Billera, Centers for Medicare & Medicaid Services


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    DEPARTMENT OF HEALTH & HÙMAN SERVICES Office of Inspector General

    Washington, D.C. 20201

    ACTION MEMORANDUM FOR THE INSPECTOR GENERAL

    Issue:

    Your signature is requested on the attached letter stating that the Michigan Medicaid False
    Claims Act, Mich. Compo Laws §§ 400.601 through 400.615, meets the requirements of section
    6031 of the Deficit Reduction Act of2005 (DRA), 42 U.S.c. § 1396h, and therefore qualifies for
    the DRA incentive.

    Discussion:

    Section 6031 of the DRA created a financial incentive for States to enact legislation that
    establishes liability to the State for individuals or entities that submit false or fraudulent claims to
    the State's Medicaid program. The incentive takes the form ofa 10-percentage point increase in
    the State's medical assistance percentage of any amounts recovered in an action brought under a
    qualifying law. For a State to qualify for this incentive, among other things, a State law must
    contain provisions that are at least as effective in rewarding and facilitating qui tam actions as the
    provisions in the Federal False Claims Act.

    Section 6031 (b) of the DRA requires the Inspector General to determine, in consultation with the
    Attorney General ofthe U.S. Department of Justice (DOJ), whether a State law meets the
    requirements in the DRA. On August 21,2006, the Office ofInspector General (OIG) published
    a notice in the Federal Register containing OIG's guidelines for determining whether a State law
    qualifies for the DRA incentive. The notice invited States to submit requests for review of State
    false claims acts to GIG.

    To date, we have approved for the DRA incentive the false claims acts of a total of 13 States-
    Massachusetts, Ilinois, Tennessee, Virginia, Hawaii, Texas, New York, Nevada, California,
    Georgia, Indiana, Rhode Island, and Wisconsin. If you sign the attached letter, we wil have
    determined that one additional state qualifies for the DRA incentive (Michigan).

    We received a request to review the Michigan Medicaid False Claims Act, found at Mich. Compo
    Laws §§ 400.601 through 400.615. Based on our review and consultation with DOJ, we believe
    that Michigan's law qualifies for the DRA incentive. OIG reviewed an earlier version of
    Michigan's law and determined that it did not quality for the DRA incentive. In December 2006,
    OIG sent a letter to Michigan explaining why its law did not qualify for the incentive. On
    July 24,2008, OIG sent a supplemental letter to Michigan setting forth additional reasons why
    Michigan's law did not qualify. The amended version of the law currently under review
    addresses all of the concerns that OIG identified in its two prior letters.
    As explained in the Action Memorandum associated with the July 24, 2008, letter, there is a
    provision in Michigan's law that DOJ believes renders it less effective than the Federal False
    Claims Act at facilitating and rewarding qui tam actions. Specifically, Michigan's law requires
    the court to award the defendant attorney's fees and expenses and to impose a civil fine of not
    more than $10,000 against the relator if the relator continues with a case that has been declined
    by the State and the court finds that the relator's case was frivolous. The Federal False Claims
    Act allows the court, in its discretion, to award a defendant attorney's fees in similar situations,
    but does not impose a civil fine. DOJ believes that this additional fine is punitive and, therefore,
    renders Michigan's law less effective in rewarding and facilitating qui tam actions. We believe
    that the Federal False Claims Act's provision is clearly punitive and that Michigan's addition of
    the $10,000 fine, although also punitive, would not significantly deter relators. Accordingly, this
    provision was not included in the July 24,2008, letter as a basis for GIG's determination that
    Michigan's law did not qualify for the incentive. This provision is also in the amended version
    of Michigan's law.

    Recommendation:

    We recommend that you sign the attached letter, stating that the law submitted by Michigan
    fulfills the requirements of the DRA.

    Decision:

    Approved: Iml Disapproved: Date: 4/5/09 .

    Attachment:

    Tab A: Michigan DRA Letter

    Contact: Katie Arnholt Telephone: (202) 205-3203

    Concurrence: l;iC Df""r/d


    Assistant Inspector General for Legal Affairs
    Date:~

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