George Breen Quoted in Article, "OIG Guidelines Incentivize States to Restructure False Claims Acts"

States looking to boost their budget may have found one way to create a little wiggle room thanks to the OIG's release of its "Updated OIG Guidelines for Evaluating State False Claims Acts." But SNFs aren't likely to share their excitement.

In March, after reviewing more than 28 different state laws, the OIG updated its 2006 guidelines describing its methodology for reviewing state false claims acts. States that restructure their false claims acts to meet OIG's requirements will receive a 10% increase in any amounts recovered.

Effective immediately, the updated requirements have been added to section 1909(b) of the Social Security Act. ...

States are also facing pressure as a result of the Affordable Care Act (ACA), which expands the number of potential Medicaid beneficiaries, says George Breen, who specializes in healthcare and life sciences litigation. ...

"You have a situation where states are faced with more budgetary pressure to deal with expanded Medicaid rolls and they will have more incentive to pursue healthcare providers," Breen says. "This clearly impacts the long-term care industry, which is heavily involved with Medicaid patients. You can expect that states will have a bigger incentive to pursue actions against providers because it's clearly to their financial benefit." ...

"While Medicare facilities have already been on notice of the fact that they have the obligation to report and return overpayments, now you're talking about situations where if states have a qualifying act, state-based Medicaid claims are now also subjected to the issue of whether there has been improper retention of an overpayment and whether that results in liability," Breen says. "Failure to report and return overpayments is one of the issues we expect to be the subject of increasing FCA litigation."