Rep. Grove leads bipartisan bill package combating $3B in Medicaid fraud

Logan Hullinger
York Dispatch

State Rep. Seth Grove will spearhead a five-bill package to combat Medicaid fraud with hopes of mitigating the estimated $3 billion taxpayers shell out annually to cover fraudulent claims in Pennsylvania.

The Dover Township Republican on Monday, Jan. 13, led a news conference in the Capitol rotunda alongside state Attorney General Josh Shapiro and a bipartisan, bicameral group of lawmakers to detail bills that would increase penalties for fraud and provide for more oversight.

"Fighting fraud and improper payments is not a Democratic or Republican issue," Grove said. "It's a good government issue that citizens expect of their government."

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 All of the bills in the package are expected to be introduced by the end of the week. Grove himself will introduce of the False Claims Act, an anti-fraud measure that is already used by 35 states and the federal government. 

In Grove's version, the state would be permitted to recover an additional 10% — on top of the money it can recover with just the federal statute — from false claims made against the state's Medicaid program. That would bring the state's share of a potential settlement from 46.75% to 57.75%.

Rep. Seth Grove (R-York), left, is joined by state Sen. Kristin Phillips-Hill (R-York Township) and other lawmakers at the Capitol rotunda as Grove and Attorney General Josh Shapiro introduced a package of bills designed to curb Medicaid fraud Monday, January 13, 2020. The press conference took place in the Capitol rotunda. Bill Kalina photo

It also would allow the Attorney General's Office to make a civil case against those who commit fraud rather than just a criminal case, Shapiro said.

Sen. Lindsay Williams, D-Allegheny, will introduce a companion bill in the Senate, which Sen. Kristin Phillips-Hill, R-York Township, will co-sponsor.

The proposal, however, didn't make it long before it was hit with opposition from the Pennsylvania Coalition for Civil Justice Reform, which claimed the state would actually recover less funds. 

"With a state-based False Claims Act, the ‘bounty-hunter’ plaintiff receives a double recovery by taking a contingency fee from both the state share of the recovery and the federal government’s share," said Curt Schroder, the organization's executive director.

Schroder called for a hearing before any action is taken on the legislation.

The lawmakers' efforts come after a grand jury report released by Shapiro last April, which detailed a variety of loopholes that hinder the state's ability to prevent and deter Medicaid fraud.

They also come after the House Government Oversight Committee, chaired by Grove, released a report making a case for the False Claims Act in November.

"Today, in 2020, we literally have no way of quantifying how much money is lost to Medicaid fraud in the commonwealth," Shapiro said at Monday's news conference.

Based on the federal government's estimates, fraud and improper payments account for up to 10% of all Medicaid spending. In Pennsylvania, that would mean about $3 billion of its $31 billion in annual spending is used to cover fraudulent claims.

Rep. Seth Grove , left, Attorney General Josh Shapiro and members of the General Assembly introduce, Monday, January 13, 2020, a package of bills designed to curb Medicaid fraud. The press conference took place in the Capitol rotunda. Bill Kalina photo

Other bills in the in the package include legislation from Rep. Clint Owlett, R-Tioga, which would create a searchable database that would identify entities that are barred from receiving funds from a state agency.

Also in the package is a bill by Rep. Tommy Sankey, R-Clearfield, that would require any Medicaid managed care organization to enter into an agreement with the state so it can track and recover Medicaid funds spent on provider preventable conditions.

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The conditions, known as PPCs, are high-cost incidents that occur while under care, such as when a surgical procedure is performed on the wrong person or wrong body part.

Finally, Rep. Wendi Thomas, R-Bucks, will introduce legislation that would make knowing of or causing a fraudulent claim a second degree felony if the claim is more $100,000 or more. Lower claims would also see harsher charges.

— Logan Hullinger can be reached at or via Twitter at @LoganHullYD.