A proposal is currently circulating in the Wisconsin Legislature that would restore a private individual’s ability to bring a qui tam claim on behalf of the government against a person who makes a false claim for Medicaid. WCJC helped repeal Wisconsin’s previous qui tam law in 2015 and will work hard to ensure that it is not enacted back into law.

 

Background on Qui Tam

Qui tam is a Latin term describing a legal action to collect a penalty through supplied information from the public. Under this legal doctrine, a private party called a “relator” may bring a whistleblower lawsuit against a party on the government’s behalf. The relator must first present the information to the government, which can decide to either pursue the case, or deny involvement and allow the plaintiff to bring the case on behalf of the state using a private plaintiff attorney.

In 2007, the Wisconsin Legislature enacted the previous qui tam law. In 2015, the law was repealed by the Legislature during the budget bill process.

 

Legislative Proposal

Rep. Lisa Subeck (D-Madison) is currently circulating a new proposal (LRB 957) to reinstate the previous qui tam law. The bill would allow private individuals to bring claims on their own behalf and on behalf of the state against persons making false claims for Medical Assistance. Under the bill, plaintiffs and their attorneys could seek up to 30 percent of all of the damages, along with attorney’s fees and costs.

There is little evidence qui tam laws accomplish the ostensible goal of detecting and recovering damages for Medicaid fraud. Instead, according to, the U.S. Chamber Institute for Legal Reform, in many instances the states with qui tam statutes may actually recover less from the average Medicaid fraud settlement than those states without, due to the state’s obligation to pay out a share of the settlement to the private party.

Restoring qui tam lawsuits in Wisconsin would simply provide an incentive for plaintiff attorneys to file costly lawsuits against medical providers, pharmaceutical companies, and any other business contracting with the state.

It’s also important to note that Wisconsin already has a law – Wis. Stat. § 49.49 – that grants the attorney general the authority to prosecute Medicaid fraud and recover damages on behalf of the state. All damages recovered under this law go to the State of Wisconsin and need not be paid out to a private party or plaintiff attorneys.

Earlier this session, Gov. Tony Evers proposed in his state budget recommendations reinstating the qui tam law, not just for alleged Medicaid fraud, but for all state agencies. WCJC actively lobbied against the qui tam provision and were successful in convincing the Joint Finance Committee to remove the provision. WCJC met with key committee members and submitted a memo explaining why the law is unnecessary and would only benefit plaintiff attorneys.

WCJC plans to similarly oppose the newly circulated bill.