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LouisianaHB 5602025 Regular SessionHouseWALLET

MEDICAID: Provides relative to the Medical Assistance Programs Integrity Act (EN SEE FISC NOTE GF RV)

Sponsored By: Peter F. Egan Sr. (Republican)

Signed by Governor

Health and Welfare

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 0 benefits, 2 costs, 5 mixed.

Health plans face stricter Medicaid duties

Managed care plans and subcontractors cannot knowingly fail to provide medical assistance services promised in their state contracts. They also cannot knowingly withhold required information or commit enrollment or marketing fraud. Health care providers must give state oversight officials information required by law, rule, or contract.

Providers face broader Medicaid fraud rules

Louisiana expands its fraud rules across Medicaid and other health department programs. Knowing misconduct includes deliberate ignorance or reckless disregard; the state need not prove a specific intent to defraud. The law bars false claims, false records, hiding money owed to programs, and agreements to break these rules. It also bars knowingly billing for unapproved or unprescribed care, substantially inadequate services, or adulterated or mislabeled products. Providers cannot knowingly give materially false facility certification information, required department information, or provider identities needed for claim payment.

Whistleblowers get recovery shares, face costs

When Louisiana proceeds with a whistleblower case, the filer receives 15%–25% of recovered proceeds, subject to statutory exceptions. Percentage shares use total proceeds from the case or settlement. If the state declines, a winning defendant can receive fees only for clearly frivolous, vexatious, or mainly harassing claims. Defendants lose the specified right to use an adverse finding to recover losses caused by the filer's lawsuit. Louisiana and its agencies are not liable for the filer's costs, legal fees, or awards against the filer.

Attorney general leads Medicaid fraud enforcement

Louisiana's attorney general must diligently investigate violations, and the health department must coordinate responsibilities through interagency agreements. The health secretary can sue only after referring the matter and receiving the attorney general's written refusal to proceed. State cases can be filed in the Nineteenth Judicial District Court in East Baton Rouge Parish or another proper court. State contracts with private lawyers, including their fees, are public records. The law also repeals several older integrity provisions.

Medicaid recovery rules tighten and loosen

The law removes the $1,000 minimum damages requirement, allowing smaller claims to reach court. Civil false-claim and illegal-payment cases use the more-likely-than-not proof standard. Related final criminal judgments, including guilty or no-contest pleas, bind defendants on the offense's essential facts in later recovery cases. Courts can reduce recovery for qualifying disclosures, but not below twice actual damages. Disclosure must precede related proceedings, and the violator must lack actual knowledge of an investigation; additional statutory requirements also apply. Settlements no longer carry this section's express requirements to cover estimated losses, specify payment methods, and secure full payment. Settlement, court-order, property-forfeiture, and penalty rules preserve private whistleblower rights.

State controls whistleblower cases and settlements

When Louisiana joins a whistleblower case, it controls proceedings; its intervention uses the original filing date for deadline purposes. Courts can limit the private filer's role if it disrupts, delays, repeats evidence, or harasses. The state can seek dismissal over the filer's objection after notice and a hearing. It can also settle over an objection after a court finds the deal fair, adequate, and reasonable. If the state declines, the filer can continue, but parties must supply requested pleadings and deposition transcripts; the state pays for transcript copies. Courts can pause evidence gathering for up to 60 days after a private showing that it interferes with related proceedings. Extensions require another showing of diligent state work and continued interference.

Whistleblowers gain lawsuits with filing limits

Private people can sue in Louisiana's name to recover money for specified medical assistance violations. They must serve the state, and filings generally remain sealed and confidential during the initial investigation. Only the state can join or bring a related action based on facts underlying a pending case. Courts must dismiss claims repeating specified public disclosures unless the state opposes dismissal or the filer qualifies as an original source. Original sources must voluntarily inform the state before filing and meet the law's source requirements. Dismissal requires written consent and reasons from both the court and attorney general.

Sponsors & Cosponsors

Sponsor

  • Peter F. Egan Sr.

    Republican • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 118 • No: 28

Senate vote • 6/2/2025

Read by title, passed by a vote of 28 yeas and 8 nays, and ordered returned to the House. Motion to reconsider tabled.

Yes: 28 • No: 8

House vote • 5/7/2025

Read third time by title, amended, roll called on final passage, yeas 76, nays 20. Finally passed, title adopted, ordered to the Senate.

Yes: 76 • No: 20

House vote • 4/29/2025

Reported with amendments

Yes: 14 • No: 0

Actions Timeline

  1. Signed by the Governor. Becomes Act No. 206.

    6/8/2025House

  2. Effective date: 08/01/2025.

    6/8/2025House

  3. Sent to the Governor for executive approval.

    6/5/2025House

  4. Enrolled and signed by the Speaker of the House.

    6/4/2025House

  5. Signed by the President of the Senate.

    6/4/2025Senate

  6. Read by title, passed by a vote of 28 yeas and 8 nays, and ordered returned to the House. Motion to reconsider tabled.

    6/2/2025Senate

  7. Received from the Senate without amendments.

    6/2/2025House

  8. Reported without Legislative Bureau amendments. Read by title and passed to third reading and final passage.

    5/28/2025Senate

  9. Read by title and referred to the Legislative Bureau.

    5/27/2025Senate

  10. Rules suspended. Reported favorably.

    5/21/2025Senate

  11. Read second time by title and referred to the Committee on Health and Welfare.

    5/12/2025Senate

  12. Received in the Senate. Read first time by title and placed on the Calendar for a second reading.

    5/8/2025Senate

  13. Read third time by title, amended, roll called on final passage, yeas 76, nays 20. Finally passed, title adopted, ordered to the Senate.

    5/7/2025House

  14. Scheduled for floor debate on 05/07/2025.

    5/6/2025House

  15. Read by title, amended, ordered engrossed, passed to 3rd reading.

    4/30/2025House

  16. Reported with amendments (14-0).

    4/29/2025House

  17. Read by title, under the rules, referred to the Committee on Health and Welfare.

    4/14/2025House

  18. Prefiled.

    4/4/2025House

  19. Under the rules, provisionally referred to the Committee on Health and Welfare.

    4/4/2025House

Bill Text

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