State False Claims Act
This installment of the Fraud by the Numbers series, we turn to the State False Claims Act (FCA) statutes. To recap several, but not all states and territories have FCA statutes and some are healthcare specific. The U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG) provides a list of State FCAs that are approved under section 1909 of the Social Security Act in discussion with the Attorney General. Table A provides a breakdown of states and territories with FCA statutes.
Table A:
*Indicates health care fraud only. Notably, the Texas Medicaid Fraud Prevention Act is quite distinct from the FCA and does not require materiality.
** Indicates section 1909 approval.
Additionally, Arkansas has a Medicaid False Claims Act but it does not include a qui tam provision. Instead of filing a private action, a whistleblower who provides information leading to a recovery for Medicaid fraud can receive a reward of up to 10%.
Every year, the U.S. Department of Justice releases an annual report for the previous fiscal year regarding FCA recoveries. For FY2024, total recoveries, some of which have a Medicaid component, exceeded $2.9 billion. When Medicaid is involved, the Federal Government and the respective State Government are allocated a portion of the recovery because Medicaid funds come from both governments.
However, quantifying exact state FCA recoveries is difficult as the information is not readily available.[1] California’s Attorney General website provides an overview of the California False Claims Act and types of cases it has handled under the law; however, no statistics are present. For example, in February 2013, the Texas Attorney General released information that Medicaid Fraud recoveries surpassed $400 million, reflecting a decade-long emphasis on combatting Medicaid fraud in Texas. The Texas Office of the Inspector General – Health and Human Services Q2 Fiscal Year 2025 Quarterly Report states that “[f]rom December 1, 2024, to February 28, 2025, the Texas Health and Human Services (HHS) Office of Inspector General (OIG) recovered more than $93.4 million.” There is no express mention of either “whistleblowers” or the Texas Medicaid Fraud Prevention Act in the report.
There have been several notable state settlements this fiscal year. In October 2024, Connecticut’s Attorney General announced a $39 million settlement against a pharmacy involving unlawful kickbacks under Connecticut’s FCA. In January 2025, the District of Columbia’s Attorney General announced a settlement with a contractor and subcontractor for $6.5 million. Additionally, California’s Attorney General announced a $47 million settlement with a company for engaging in illegal kickbacks in January 2025. These settlements and the continued growth of state-level FCA legislation demonstrate the ongoing state commitment to combat fraud.
[1] In 2021, TAF published state FCA settlement totals of eleven (11) states, which was based on Attorney General press releases.
This piece was written by Rachel Rose.
