Articles Tagged with Medicaid fraud

samuel-zeller-360588-copy-200x300Two California urologists, Dr. Aytac Apaydin and Dr. Stephen Worsham, have agreed to pay $1.085 million based on allegations of violating the False Claim Act, the Anti-Kickback Statute, and Stark Law, which prohibits physician self-referral, between April 2008 and December 2014.

Apaydin and Worsham currently own and run Salinas Valley Urology Associates. They also owned the Advance Radiation Oncology Center (AROC), which was shut down in 2016. The physicians were accused of submitting and causing to be submitted false claims to Medicare in relation to image guided radiation therapy (IGRT), which is used to treat cancer patients at AROC. The claims were false based on the fact that the services arose from illegal kickbacks and self-referrals.

An Illegal Referral and Kickback Scheme

Last week, we looked at the recoveries made on behalf of the federal government using the False Claims Act (“FCA”) in 2015.  While informative, those numbers don’t tell the whole story.  Many states have their own versions of the FCA.  These statutes are particularly important in the Medicaid fraud arena since Medicaid is a state and federal partnership so fraud typically involves both federal and state funds.  Today, our government fraud law firm looks at one such statute, Washington’s Medicaid Fraud False Claims Act (“WFCA”).  Each state’s laws are unique, but this review can help readers understand the importance of state claims in this arena.

Washington’s Legislative Auditor Reviews the State False Claims Act, Recommends Reauthorization

In 2015, with the WFCA set to expire on June 30, 2016, the healthcashstate’s Legislative Auditor undertook to study the statute, its results, and recommend or counsel against reauthorization.  As the resulting report (Proposed Final Report issued 12/16/15) explains, government can investigate possible Medicaid fraud via federal (civil and/or criminal) investigations, state criminal investigations, and state civil investigations.  Absent reauthorization, Washington would lose the authority for the final category.  Additionally, if the federal government is investigating a case that also involved fraud on Washington state, the state can only participate in the case and any recovery if it has a state FCA that (like the WFCA) meets certain standards set forth in the federal law.