HEALTH REFORM: OIG Issues Updated Guidelines for Evaluating State False Claims Acts: Is More State Litigation on the Horizon?

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On March 15, 2013, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) released the Updated OIG Guidelines for Evaluating State False Claims Acts (“2013 Guidelines”), which replaces the original version released in 2006 (“2006 Guidelines”). The 2013 Guidelines describe OIG’s methodology for determining whether a state’s Medicaid false claims law satisfies the four requirements in Section 1909(b) of the Social Security Act (“Act”) that are necessary to qualify for a 10-percentage-point increase in the state share of Medicaid-related false claims recoveries.

The 2013 Guidelines also provide more specific insight into OIG’s review process when evaluating state false claims laws and are based on OIG’s experience in reviewing over 28 different state false claims laws. Unlike the 2006 Guidelines, the 2013 Guidelines reflect the three amendments to the federal False Claims Act (“FCA”) that have occurred since Section 1909 of the Act was passed. Generally, these three amendments to the FCA, modified, in significant part, the bases for FCA liability; expanded the rights of qui tam relators; and added a requirement that civil monetary penalties (“CMPs”) include adjustments under the Federal Civil Penalties Inflation Adjustment Act of 1990.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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