State False Claims Act...Fraud Fighter? or Physician Practice Destroyer?

Written by Executive Vice President, Public Policy and Association Affairs, Andy Sandusky

June 19, 2020

No one, including POMA, supports fraud, waste or abuse in any form, especially in the Medicaid program, where any fraud, waste or abuse takes money away from our most vulnerable population. Legislative efforts are underway in Pennsylvania to enact a state false claims act with the intent of beefing up the Attorney General’s policing powers to go after Medicaid fraud.  However, POMA has more questions than answers about the 38-pages of legal text of the pending legislation. As drafted, only a seasoned prosecutor, plaintiff’s counsel or defense lawyer would truly understand. what the bill requires of physicians.

House Bill 2352 was moved from the committee last week and is poised for a full vote in the House chamber in the upcoming week.  POMA’s immediate concern is to protect physician practices that make honest mistakes versus those who are gaming the system with the intent to defraud.

As currently drafted, HB 2352:

  • Makes physicians liable without any proof of intent to defraud the government.
  • Does not draw a bright line so that a physician practice can know what it needs to do in order to decrease their exposure to potential fraud liability when billing for care they provide to Medicaid patients. 
  • Permits the Attorney General look back at a physician billing records for the past 10 years to make a case. 
  • Requires for each patient billing, if deemed fraud by the Attorney General, a physician will be liable for $8,000 penalty per claim
  • Practically requires, that before you even begin the process of defending yourself, you will need to hire an attorney out of your own pocket. 
  • Provides if you lose, you will be responsible not only for your own attorney fees, but the cost of the investigation and attorney fees spent by the Attorney General

POMA opposes HB 2352 as it is currently drafted and is pleading with lawmakers to slow down the process and not vote on it next week. HB 2352 is supported by the trial lawyers and the Attorney General.  It is opposed by physicians, hospitals, nursing homes, insurance companies and pharmaceutical companies.