Washington State Medicaid Fraud False Claims Act

In 2012, the State of Washington passed the Washington State Medicaid Fraud False Claims Act (“Washington Medicaid FCA”), its own version of the federal False Claims Act (“FCA”). The Washington Medicaid FCA allows private individuals who know about Medicaid fraud 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 Washington Medicaid FCA only applies to fraud against Washington’s Medicaid Program, called Apple Health.

Like the federal FCA, the Washington Medicaid FCA offers financial rewards to whistleblowers for bringing an action on behalf of the State. If the State decides to intervene in a 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, they may receive 25-30% of the recovery.

Washington Medicaid FCA and Federal FCA Similarities

Key provisions of the Washington Medicaid FCA mirror the federal FCA, such as:

1. Liability attaches under the Washington Medicaid FCA for, among other violations: submitting a false claim for payment to the State, or making or using a false record or statement material to a false claim.
2. A private citizen who knows about Medicaid fraud against the State of Washington can bring a claim on behalf of the State. If the Washington Attorney General decides not to pursue the case, the individual has the right to proceed with the litigation in Court.
3. Once an action is brought under the Washington Medicaid FCA, it remains under seal for at least 60 days (the State can, and almost always does, petition the Court to request an extension of the initial 60-day seal period).
4. Employers are prohibited 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, including litigation costs and reasonable attorney fees.

Unique Provisions of the Washington Medicaid FCA

While the Washington Medicaid FCA and the federal FCA have numerous similarities, they also have several differences:

1. As previously stated, the Washington Medicaid FCA only applies to fraud committed against Washington’s Medicaid program, Apple Health. The federal FCA applies to all types of fraud committed against the government.
2. Funds recovered under the Washington Medicaid FCA must be deposited in the Medicaid Fraud Penalty Account, which is dedicated to continuing to fight fraud as well as serve Medicaid beneficiaries.  The designated ways in which the Medicaid Fraud Penalty Account money must be spent include spending on Medicaid services, fraud detection and prevention activities, other Medicaid fraud enforcement activities, or the prescription monitoring program.

For more information on the Washington Medicaid FCA or to speak with an attorney, please contact Berger Montague at [email protected].