The Louisiana Medical Assistance Programs Integrity Law (“Louisiana FCA”) is the State of Louisiana’s version of the federal False Claims Act (“FCA”).
The Louisiana FCA allows private individuals who know about fraud against Louisiana’s medical assistance programs to bring a qui tam case against a person or entity for submitting or causing the submission of false claims to the State. As its title indicates, the Louisiana FCA only applies to fraud against Louisiana’s medical assistance programs, including Medicaid.
Like the federal FCA, the Louisiana FCA allows for financial rewards to whistleblowers for bringing an action on behalf of the State. If the State decides to intervene in the case, the whistleblower may receive 15-25% of the recovery. If the State does not intervene and the whistleblower pursues the case on their own, the whistleblower may receive 25-30% of the recovery.
Liability attaches under the Louisiana FCA for:
- Soliciting, receiving, offering, or paying any remuneration to or from healthcare providers, including but not limited to kickbacks, bribes, rebates, or bed hold payments, directly or indirectly, overtly or covertly, in cash or in kind;
- Knowingly submitting or causing to be submitted a false claim to the State;
- Knowingly making or using a false record or statement material to a false claim;
- Knowingly making or using a false record or statement material to an obligation to pay or transmit money or property to the State medical assistance programs;
- Knowingly concealing, avoiding, or decreasing an obligation to pay or transmit money or property to the State medical assistance programs;
- Conspiring or attempting to defraud the State medical assistance programs through misrepresentation or by obtaining payment for a false claim;
- Knowingly submitting a claim for goods, services, or supplies which were medically unnecessary or of substandard quality or quantity; and
- Knowingly making or using a false statement on a form used to certify or qualify a person for eligibility for the medical assistance programs.
Louisiana FCA and Federal FCA Similarities
Key provisions of the Louisiana FCA mirror the federal FCA, such as:
- Louisiana can recover triple the amount it was defrauded, plus up to $11,000 per violation.
- A private citizen who knows about fraud against Louisiana’s medical assistance programs can bring a claim on behalf of the State. If the Louisiana Attorney General decides not to pursue the case, the citizen has the right to proceed in Court.
- The Louisiana FCA prohibits employers from retaliating against whistleblower employees. Retaliation includes firing, demoting, suspending, threatening, or harassing the employee. If the employer does retaliate, the employee is entitled to the reinstatement of their position, two times the amount of back pay, interest on the back pay, and compensation for any damages sustained because of the discrimination.
Louisiana FCA and Federal FCA Differences
While the Louisiana FCA and the federal FCA have numerous similarities, they also have several differences:
- As previously stated, the Louisiana FCA only applies to fraud committed against Louisiana’s medical assistance programs, including Medicaid. The federal FCA applies to all types of fraud committed against the government.
- Unlike the federal FCA, the Louisiana FCA exempts claims involving less than $1,000.
- While qui tam actions brought under the federal FCA remain under seal for at least 60 days, actions brought under the Louisiana FCA must remain under seal for at least 90 days.
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