In a recent article by Law360 Healthcare Authority, reporter Dan McKay examined how HHS's unprecedented move to cut funding for Medicaid Fraud Control Units in New York and Hawaii could reshape enforcement priorities for units nationwide.
Sarah M. Hall and Allison R. Ness, Members of the Firm in the Health Care & Life Sciences practice of Epstein Becker Green, both offered perspective on what the decertifications signal for states and providers.
Sarah noted that the OIG letters reflect a broader administration effort to exert control over who gets prosecuted, for what, and on what timeline. The pressure on indictment counts may push states toward smaller, faster prosecutions, and create real risk that thinner cases get charged. More than a dozen states face recertification deadlines by October 1, and attorneys general are reading the letters closely as a road map for staying compliant. She warned the metric-driven push could backfire.
"Pressure from HHS could result in 'half-baked cases getting charged, which presents a lot of opportunities, we think, for the defense bar to watch these cases closely and to really examine and evaluate whether these cases are truly supported by evidence,'" Hall said.
Allison identified three themes running through both letters: concern about staffing levels, whether units are acting on prosecution referrals from health care organizations, and whether cases are moving at an appropriate pace. For providers billing Medicaid in any state, she said now is the time to verify that compliance programs are working in practice, not just on paper.
"That's really where you can get in trouble — if you think you set up your practice appropriately, but then no one's really following the rules you set out," Ness said.
Get in Touch
To discuss this perspective, contact Sarah Hall at smhall@ebglaw.com or Allison Ness at aness@ebglaw.com.
