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State False Claims Act Reviews

The OIG, in consultation with the Attorney General, determines whether States have false claims acts that qualify for an incentive under section 1909 of the Social Security Act. Those States deemed to have qualifying laws receive a 10-percentage-point increase in their share of any amounts recovered under such laws.

To qualify for the financial incentive, a State’s false claims act must:

  • establish liability to the State for false or fraudulent claims, as described in the Federal False Claims Act (FCA), with respect to Medicaid spending,
  • contain provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as those described in the FCA,
  • contain a requirement for filing an action under seal for 60 days with review by the State Attorney General, and
  • contain a civil penalty that is not less than the amount of the civil penalty authorized under the FCA.

Since the effective date of section 1909 of the Social Security Act, the FCA has been amended by the Fraud Enforcement and Recovery Act of 2009 (FERA), the Patient Protection and Affordable Care Act (ACA), and the Dodd-Frank Wall Street Reform and Consumer Protection Act (the Dodd-Frank Act). These three acts, among other things, amended bases for liability in the FCA and expanded certain rights of qui tam relators.

As a result of these amendments to the FCA, OIG will: (1) analyze section 1909 compliance using the FCA as amended; and (2) provide a 2-year grace period, ending on March 31, 2013, during which State acts that were previously approved by OIG will continue to be deemed compliant pending State act amendment and resubmission to OIG. Therefore, all State acts that have not yet been approved will be reviewed in reference to the FCA as amended by the FERA, the ACA, and the Dodd-Frank Act. State acts that have been approved in the past will be considered compliant until March 31, 2013. After March 31, 2013, a previously approved State act will no longer qualify for the section 1909 incentive unless it has been: (1) amended and resubmitted to OIG; and (2) either: (a) approved by OIG; or (b) under review by OIG.

To request a review of a false claims act, States should submit a complete copy of the law and any other relevant information to:

Office of Inspector General
Office of Counsel to the Inspector General
U.S. Department of Health & Human Services
Cohen Building , Mail Stop 5527
330 Independence Avenue, SW
Washington, DC 20201

OIG also invites States with draft legislation to submit their drafts for informal review and discussion before the draft legislation is passed.

State Laws Reviewed by OIG

References/Statutory Authorities

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201