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Federal and State Program Integrity in Washington

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        The state has a number of laws protecting the integrity of federal and state medical assistance programs from fraud and abuse.  Washington law requires that any person who has been overpaid by the state Medicaid program, must return the excess funds plus interest.1

         The law also makes it a felony to make a false statement or misrepresentation of a material fact in the application or for payment for a medical assistance service.2  Any individual who offers or accepts a bribe or kickback in the provision of publicly paid health services is guilty of a felony.   In order to investigate any allegations of fraud and abuse, the law gives the Secretary or Director of the Department of Social and Health Services access to patient records for billing purposes.3

 

Footnotes

  • 1. Wash. Rev. Code § 74.09.220
  • 2. Wash. Rev. Code § 74.09.230; Wash. Rev. Code § 74.09.210
  • 3. Wash. Rev. Code § 74.09.290

 

Federal and State Program Integrity in Washington

Subtopic Statute/Regulation Description
Penalties for false claims Wash. Rev. Code § 70.225.060 Violations — Penalties — Disclosure exemption for health care providers Dispensers that fail to report or knowingly report incorrect...
Wash. Rev. Code § 74.09.210 Fraudulent practices — Penalties Individuals or entities may not, by willful false statement, misrepresentation, or fraudulent act, obtain or...
Wash. Rev. Code § 74.09.220 Liability for receipt of excess payments Individuals or entities receive, without intent, excess payments for medical services are liable for the...
Wash. Rev. Code § 74.09.230 False statements, fraud — Penalties Individuals or entities are guilty of a felony for:        ...
Fraud and abuse provisions about Medicaid or Medicare: Anti-kickback laws Wash. Rev. Code § 74.09.240 Bribes, kickbacks, rebates — Self-referrals — Penalties Individuals or entities are guilty of a felony if they solicit, receive, offer,...
Other Wash. Rev. Code § 74.09.290 Audits and investigations of providers — Patient records — Penalties The Secretary or Director of the department of social and health...
Click on the individual state law in the table above to see our summary of the individual law.


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by Dr. Radut.