Massachusetts Medicaid fraud rises to nearly $17 million up 9 percent but whistleblowers also increasing

Massachusetts Whistleblower Law

Massachusetts Medicaid fraud hit a new record, rising to  $17 million, says the state auditor. Suzanne Bump. Bump released an annual report Monday outlining a nine percent year-over-year increase in public assistance benefit fraud in fiscal year 2017. She noted that the fraud “represents a small percentage of overall spending, but has a disproportionate impact in weakening public trust in these programs.” The average amount of fraud found after investigations are complete comes to $14,678.

The Massachusetts state budget is about $40 billion a year.

Her office said the increase in the amount of fraud doesn’t mean necessarily there’s more fraud, but reflects investigators’ usage of better data analytics to find the fraud and a focus on the “most egregious perpetrators” of public benefit fraud. In addition, the number of individuals coming forward as whistleblowers to reveal Medicaid fraud in Massachusetts is increasing. The Massachusetts False Claims Act, allows an individual to advance a lawsuit on behalf of the state revealing Medicaid fraud and to collect a reward of up to 30% of what the state collects as a result of the suit. The state law is modeled mostly on the federal False Claims Act.  Initially, after filing, the Massachusetts Attorney General’s Office reviews the suits for a period to determine whether it wishes to intervene along with the whistleblower. Recent whistleblower awards here have increased and the Commonwealth has intervened in more cases.

As in previous years, most of the fraud, 61 percent, occurred within MassHealth the state-federal Medicaid healthcare program for low and medium income Bay State residents. The total amount of MassHealth fraud came to $10.3 million. The food stamp program had $4 million in fraud efforts. Bump’s office identified 1,150 cases with fraud in fiscal year 2017. In fiscal year 2016, there were 1,045 cases with identified fraud, and an average of $14,783 per fraud case.

Jeffrey Newman represents whistleblowers