Louisiana False Claims Act Information

Louisiana False Claims Act allows whistleblowers to report violations of the state’s medical assistance programs and receive 15-30% of the proceeds

The Louisiana False Claims Act is limited to claims related to its Medical Assistance programs. A private person can file a civil action on behalf of the medical assistance programs to seek recovery for a violation of sections 46:438.2-438:4 of the Louisiana Medical Assistance Programs Integrity Law. In a successful action, the whistleblower is entitled to 15-30% of the proceeds; plus an amount for reasonable case costs, expenses, fees, and attorney fees.

The Louisiana False Claims Act—RS 46 438.1 et seq.— also protects whistleblowers against retaliation for engaging in protected activity.

Violations of Section 438.2 relate to illegal remuneration:

1. No person shall solicit, receive, offer, or pay any remuneration, including but not limited to kickbacks, bribes, rebates, or bed hold payments, directly or indirectly, overtly or covertly, in cash or in kind, for the following:

  • In return for referring an individual to a health care provider, or for referring an individual to another person for the purpose of referring an individual to a health care provider, for the furnishing or arranging to furnish any good, supply, or service for which payment may be made, in whole or in part, under the medical assistance programs.
  • In return for purchasing, leasing, or ordering, or for arranging for or recommending purchasing, leasing, or ordering, any good, supply, or service, or facility for which payment may be made, in whole or in part, under the medical assistance programs.
  • To a recipient of goods, services, or supplies, or his representative, for which payment may be made, in whole or in part, under the medical assistance programs.
  • To obtain a recipient list, number, name, or any other identifying information.

2. An action brought pursuant to the provisions of this Section shall be instituted within one year of when the department knew that the prohibited conduct occurred. Such prohibited conduct shall be referred to in this Part as “illegal remuneration”.

3. By rules and regulations promulgated in accordance with the Administrative Procedure Act, the secretary may provide for additional “safe harbor” exceptions to which the provisions of this Section shall not apply.

4. The following are “safe harbor” exceptions to which the provisions of this Section shall not apply:

  • A discount or other reduction in price obtained by a health care provider under the medical assistance programs if the reduction in price is properly disclosed to the department and is reflected in the claim made by the health care provider.
  • Any amount paid by an employer to an employee, who has a bona fide employment relationship with such employer, for the provision of covered goods, services, or supplies.
  • Any discount amount paid by a vendor of goods, services, or supplies to a person authorized to act as a purchasing agent for a group of health care providers who are furnishing goods, services, or supplies paid or reimbursed under the medical assistance programs provided the following criteria are met:
    • -The person acting as the purchasing agent has a written contract with each health care provider specifying the amount to be paid to the purchasing agent, which amount may be a fixed amount or a fixed percentage of the value of the purchases made by each such health care provider under the contract, or a combination of both.
    • -The health care provider discloses the information contained in the required written contract to the secretary in such form or manner as required under rules and regulations promulgated by the secretary in accordance with the Administrative Procedure Act.
  • Any other “safe harbor” exception created by federal or state law or by rule.

Violations of Section 438.3 relate to false or fraudulent claim and misrepresentation:

1. No person shall knowingly present or cause to be presented a false or fraudulent claim.

2. No person shall knowingly engage in misrepresentation or make, use, or cause to be made or used, a false record or statement material to a false or fraudulent claim.

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

4. No person shall conspire to defraud, or attempt to defraud, the medical assistance programs through misrepresentation or by obtaining, or attempting to obtain, payment for a false or fraudulent claim.

5.

  • No person shall knowingly submit a claim for goods, services, or supplies which were medically unnecessary or which were of substandard quality or quantity.
  • If a managed care health care provider or a health care provider operating under a voucher system under the medical assistance programs fails to provide medically necessary goods, services, or supplies or goods, services, or supplies which are of substandard quality or quantity to a recipient, and those goods, services, or supplies are covered under the managed care contract or voucher contract with the medical assistance programs, such failure shall constitute a violation of Paragraph (1) of this Subsection.
  • “Substandard quality” in reference to services applicable to medical care as used in this Subsection shall mean substandard as to the appropriate standard of care as used to determine medical malpractice, including but not limited to the standard of care provided in R.S. 9:2794.

6. Each violation of this Section may be treated as a separate violation or may be combined into one violation at the option of the secretary or the attorney general.

7. No action shall be brought under this Section unless the amount of alleged actual damages is one thousand dollars or more.

8. No action brought pursuant to this Section shall be instituted later than ten years after the date upon which the alleged violation occurred.

Violations of §438.4 relate to illegal acts regarding eligibility and recipient lists:

  1. No person shall knowingly make, use, or cause to be made or used a false, fictitious, or misleading statement on any form used for the purpose of certifying or qualifying any person for eligibility for the medical assistance programs or to receive any good, service, or supply under the medical assistance programs which that person is not eligible to receive.
  2. No unauthorized person, or no authorized person for an unauthorized purpose, shall obtain a recipient list, number, name, or any other identifying information, nor shall that person use, possess, or distribute such information.
  3. An action brought pursuant to the provisions of this Section shall be instituted within one year of when the department knew that the prohibited conduct occurred.

Violators shall be liable to the state for $5,500-$11,000 for each false or fraudulent claim, misrepresentation, illegal remuneration, or other prohibited act as contained in R.S. 46:438.2, 438.3, or 438.4. In addition, 1.) violators of section 438.2 are subject to a civil fine of up to $10,000 per violation, or an amount equal to 3 times the value of the illegal remuneration, whichever is greater; 2.) violators of Section 46:438.3 are subject to a civil fine of up to 3 times the amount of actual damages sustained by the medical assistance programs as a result of the violation.

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