by Lyn S. Savoie

Earlier this year, I wrote an article regarding the Office of Inspector General’s (“OIG”) December 2006 review of Louisiana’s Medical Assistance Programs Integrity Law (“MAPIL”). At that time, the OIG had determined that MAPIL did not meet the requirements outlined in Section 6031 of the Deficit Reduction Act of 2005 (“DRA”) and, therefore, Louisiana was not entitled to the financial incentives outlined in the DRA. In my January 2007 article, I mentioned that it was likely Louisiana would amend MAPIL to comply with the DRA requirements. It now appears that the legislature has attempted to do just that.

Act 14 of the 2007 Regular Session amends MAPIL to address the issues identified by the OIG. During the OIG’s 2006 review, it had noted that the following items were missing from Louisiana’s law:

(1)           the ability for the State to intervene in an action for good cause, even if the State initially elected not to proceed with the action;

(2)           a reward of between 15% and 25% to a relator in qui tam actions where the State intervened (the existing Louisiana law only allowed between a 10% and 20% recovery for the relator);

(3)           a floor of 25% for the relator’s share of recovery when the State did not intervene (the existing Louisiana law did not have a floor);

(4)           a floor for civil penalties for each false claim (the State law contained a ceiling, but no floor).

The 2007 revisions add all of the items the OIG found were missing from MAPIL. In addition, the statute defining false or fraudulent claims was amended to include the following prohibition:

No person shall knowingly make, use, or cause to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the medical assistance programs.

When the OIG conducted its review, it stated that if MAPIL was amended to include the requested items, then the OIG would reconsider whether the law met the DRA requirements. Now that MAPIL has been amended, the State likely will resubmit it to the OIG for review with the hope of receiving a 10-percent increase in its share of Medicaid fraud recoveries from actions brought under the State act. If approved, Louisiana may soon begin promoting enforcement actions under MAPIL.