Medicaid is a governmental program of medical assistance to the needy. Medicaid is provided to persons with low incomes. This program was established under the law of the Kerr-Mills in 1960 (Kerr – Mills Act) and carried out since 1965. An essential part of program participants are children from families with low incomes or the elderly. The largest costs are for those people who stay in nursing homes for a long time, as well as a medical assistance for the disabled.
Coughlin and Zuckerman (2008) stated that “Medicaid is the nation’s major public financing system that provides health care coverage to low-income families, the elderly, and individuals with disabilities” (p. 210).
Thus, this paper introduces the information on the False Claims Act, the Medicaid Integrity Plan, and the Federal Deficit Reduction Act. It explores and discusses the False Claims Act, the Medicaid Integrity Plan, and the Federal Deficit Reduction Act and outlines how each program is used to control costs associated with the Medicaid program.
To start with, the False Claims Act is a federal law or a special procedure that is aimed at controlling different companies and individuals who deceive various governmental and national programs. The U.S. law contains a special mechanism that is called “qui tam.” This tool allows people to sue, in the name of the government, to return the stolen costs.
Edwards (2010) emphasized that “federal health programs have had giant fraud and abuse problem for decades despite various efforts at reducing it” (Fraud and Abuse section, para. 1). Consequently, the False Claims Act was implemented as a key strategy in order to prevent and reduce Medicaid fraud and abuse. Supporting this fact, it is important to say that “the False Claims Act was passed in 1863 in response to revelations of corruption and mismanagement by government officials and of profiteering and supplying of defective goods by contractors…” (“The Federal,” 1956, p. 1107).
Moreover, it is possible to note that the government disclosed $ 22 billion with the help of the False Claims Act between 1987 and 2008. Therefore, the government has been effective in controlling costs and limiting Medicaid fraud and abuse.
Taking everything into account, it can be said that “…the False Claims Act is aimed at establishing a law enforcement “partnership” between federal law enforcement officials and private citizens who learn of fraud against the Government” (Kaiser Saurborn & Mair, P.C., 2000, para. 7).
Observing the Medicaid Integrity Plan, it should be stated that this program was created with the purpose of preventing Medicaid fraud. In addition, it provides an opportunity to recover and reduce unsuitable payments. Thus, the Medicaid Integrity Program plays an essential role in controlling costs and protects the integrity of the Medicaid program at the national level.
The Federal Deficit Reduction Act (also known as the Deficit Reduction Act of 2005) is the U.S. law that regulates the budget. This legislation influences national programs, such as Medicare and Medicaid. Over five years, this act economizes around $ 40 billion from national spending programs through the slowdown in spending on Medicaid and Medicare, improving and changing different measures.
Taking the above-mentioned information into consideration, it is possible to draw a conclusion that the programs listed above are used to control the costs associated with the Medicaid program. All these programs are very important mechanisms for the Medicaid program that are aimed at reducing and controlling Medicaid fraud and abuse. The Medicaid program provides nursing care or medical treatment to the citizens with disabilities, including children, pregnant women, and parents of children entering under the program, the disabled and elderly people who need a special attention and care.
Coughlin, T. A., & Zuckerman, S. (2008). State Responses to New Flexibility in Medicaid State Responses to New Flexibility in Medicaid. The Milbank Quarterly, 86 (2), 209-240.
Edwards, C. (2010). Medicaid Reforms. Downsizinggovernment.org. Retrieved June 20, 2011, from http://www.downsizinggovernment.org/hhs/medicaid-reforms
Kaiser Saurborn & Mair, P.C. (2000). The False Claims Act. Findlaw.com. Retrieved June 20, 2011, from http://library.findlaw.com/2000/Nov/1/130252.html
The Federal False Claims Act: The Informer as Plaintiff. (1956). Harvard Law Review, 69 (6), 1106-1115.