Arkansas False Claims Act

  • Home
  • Arkansas False Claims Act

Does Arkansas Have a False Claims Act?

Yes. Arkansas has its own False Claims Act known as The Arkansas Medicaid Fraud False Claims Act or Arkansas Qui Tam Statute, and is outlined in the Arkansas Code § 20-77-901-911. Similar to the Federal False Claims Act, it’s a detailed law designed to fight government fraud. 

How is the Arkansas False Claims Act Different from the Federal False Claims Act?

 

Only fraud against the State’s Medicaid program is actionable, and the whistleblower award under the Arkansas Qui Tam Statute is restricted to a maximum of 10% of the amount recovered by the State.

However, under the Federal False Claims Act, the whistleblower receives 15-30% of the government recovery. 

Finally, the statute of limitations under the Arkansas Qui Tam Statute is 5 years., which is different than the statute of limitations for other False Claims Acts which is typically 6-10 years.

What is the text of the Arkansas False Claims Act?

A full text of the The Arkansas Medicaid Fraud False Claims Actcan be found below:

As used in this subchapter:

  1. (1) “Arkansas Medicaid Program” means the program authorized under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., that provides for payments for medical goods or services on behalf of indigent families with dependent children and of aged, blind, or disabled individuals whose income and resources are insufficient to meet the cost of necessary medical services, including all transactions through the actual delivery of healthcare goods or services to a Medicaid recipient regardless of whether the healthcare goods or services are paid for directly by the Department of Human Services or indirectly through a fiscal agent, contractor, subcontractor, risk-based provider organization, managed care organization, or individual;

  2. (2)

    1. (A) “Claim” means any request or demand for money or property, regardless of whether under a contract, that:

      1. (i) Is presented to an officer, employee, agent, or fiscal agent of the Arkansas Medicaid Program; and

      2. (ii) Is made to a contractor, grantee, or other recipient if:

        1. (a) The money or property is spent or used on behalf of the Arkansas Medicaid Program or to advance the Arkansas Medicaid Program or its interest; and

        2. (b) The Arkansas Medicaid Program:

          1. (1) Provides or has provided any portion of the money or property requested or demanded; or

          2. (2) Is reimbursing the contractor, grantee, or other recipient for any portion of the money or property that is requested or demanded.

            1. (A) An express or implied contract, grantor-grantee, or licensor-licensee relationship;

            2. (B) A fee-based or similar relationship;

            3. (C) State law or rule;

            4. (D) Federal law or regulation; or

            5. (E) Retention of any overpayment not returned within sixty (60) days from the date of discovery by the provider;

    2. (B) “Claim” includes:

      1. (i) Billing documentation;

      2. (ii) All documentation required to be created or maintained by law or rule to justify, support, or document the delivery of healthcare goods or services to a Medicaid recipient;

      3. (iii) All documentation submitted to justify or help establish a unit rate, capitated rate, or other method of determining what is to be paid for healthcare goods or services delivered to Medicaid recipients; and

      4. (iv) All transactions in payment for healthcare goods or services delivered or claimed to have been delivered to Medicaid recipients under the Arkansas Medicaid Program regardless of whether the State of Arkansas has title to the money or property or has transferred responsibility for delivering healthcare services to another legal entity;

  3. (3) “Damages” means the actual loss to the Arkansas Medicaid Program and its fiscal agents, including the total amount of all claims paid as a result of any false claim and the value of healthcare goods or services paid for but not delivered to a Medicaid recipient;

  4. (4) “Fiscal agent” means any individual, firm, corporation, professional association, partnership, organization, risk-based provider organization, managed care organization, or other legal entity that receives, processes, or pays claims for the delivery of healthcare goods and services to Medicaid recipients under the Arkansas Medicaid Program;

  5. (5)

    1. (A) “Knowing” or “knowingly” means that the person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information.

    2. (B) “Knowing” or “knowingly” does not require proof of a specific intent to defraud;

  6. (6) “Managed care organization” means a health insurer, Medicaid provider, or other business entity authorized by state law or through a contract with the state to receive a fixed or capitated rate or fee to manage all or a portion of the delivery of healthcare goods or services to Medicaid recipients;

  7. (7) “Material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property;

  8. (8)

    1. (A) “Medicaid provider” means a person, business organization, risk-based provider organization, or managed care organization that delivers, purports to deliver, or arranges for the delivery of healthcare goods or services to a Medicaid recipient under the Arkansas Medicaid Program.

    2. (B) “Medicaid provider” includes an employee, agent, representative, contractor, or subcontractor of a person, business organization, risk-based provider organization, or managed care organization;

  9. (9) “Medicaid recipient” means any individual on whose behalf any person claimed or received any payment or payments from the Arkansas Medicaid Program or its fiscal agents, whether or not the individual was eligible for benefits under the Arkansas Medicaid Program;

  10. (10) “Obligation” means an established duty arising from:

  11. (11) “Person” means any:

    1. (A) Medicaid provider of goods or services or any employee, independent contractor, or subcontractor of the Medicaid provider, whether that provider be an individual, individual medical vendor, firm, corporation, professional association, partnership, organization, risk-based provider organization, managed care organization, or other legal entity; or

    2. (B) Individual, individual medical vendor, firm, corporation, professional association, partnership, organization, risk-based provider organization, managed care organization, or other legal entity, or any employee of any individual, individual medical vendor, firm, corporation, professional association, partnership, organization, risk-based provider organization, managed care organization, or other legal entity, not a Medicaid provider under the Arkansas Medicaid Program but that provides goods or services to a Medicaid provider under the Arkansas Medicaid Program for which the Medicaid provider submits claims to the Arkansas Medicaid Program or its fiscal agents; and

  12. (12)

    1. (A) “Records” means all documents in any form that disclose the nature, extent, and level of healthcare goods and services provided to Medicaid recipients.

    2. (B) “Records” includes X-rays, magnetic resonance imaging scans, computed tomography scans, computed axial tomography scans, and other diagnostic imaging commonly used and retained as part of the medical records of a patient.

RELEVENT STATUTES
AR Code § 21-1-601–608 (public employees) 
ARKANSAS  Whistleblower News
GOVERNMENT AGENCIES
Alaska False Claims Act Cases
McKesson Corp, 2019

State of Arkansas v. McKesson Corporation, which was settled in 2019 for $175 million. The case alleged that McKesson, a pharmaceutical distributor, violated the AFCA by inflating drug prices and overcharging the state’s Medicaid program. This settlement is the largest in the state’s history and serves as a warning to other companies that may attempt to defraud the state.

Ortho-McNeil-Janssen Pharmaceuticals, Inc., 2012

The company was charged with illegal drug promotion and bribing doctors. It was settled in 2012 for $1.2 billion, with Arkansas getting $45 million.