S4806A-2011 Actions

• Jan 4, 2012: REFERRED TO HEALTH
• May 26, 2011: PRINT NUMBER 4806A
• May 26, 2011: AMEND AND RECOMMIT TO HEALTH
• Apr 27, 2011: REFERRED TO HEALTH

S4806A-2011 Memo

BILL NUMBER:S4806A

TITLE OF BILL:
An act
to amend the public health law, in relation to enforcement actions by
the office of the Medicaid inspector general

PURPOSE:
To align the extrapolation rate used by the State Medicaid
Inspector General with the rate used by federal government in
Medicaid audits.

SUMMARY OF PROVISIONS:
Section one amends the public health law by
adding language that requires the Medicaid Inspector General to
determine that any error exceeds a rate of 5% in the audited sample
prior to applying any extrapolation method.

JUSTIFICATION:
In 2006 the Legislature created the Office of the
Medicaid Inspector General (OMIG) to coordinate anti-fraud efforts
within the Medicaid program. The Legislative intent of enacting
statute states that the OMIG was intended to "create a more efficient
and accountable structure, dramatically reorganize and streamline the
state's process of detecting and combating Medicaid fraud and abuse
and maximize the recoupment of improper Medicaid payments." At the
time of passage, there was nearly unanimous support for an
institution to crack down on fraud within the Medicaid system.

This bill will ensure that billing errors or oversights are not
confused with fraud or systematic problems resulting in overbilling
the Medicaid system. By limiting any extrapolation to the rate
utilized by the federal Department of Health and Human Services,
State audits will mirror the standards set by the US Centers for
Medicare and Medicaid Services.

LEGISLATIVE HISTORY:
New Bill.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect next succeeding January,
and apply to enforcement actions commenced on or after such date.

S4806A-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 4806--A
 2011-2012 Regular Sessions
 I N  SENATE
 April 27, 2011
 
 Introduced  by  Sens.  MARCELLINO,  CARLUCCI  --  read twice and ordered
 printed, and when printed to be committed to the Committee  on  Health
 --  committee  discharged,  bill amended, ordered reprinted as amended
 and recommitted to said committee
 

AN ACT to amend the  public  health  law,  in  relation  to  enforcement
 actions by the office of the Medicaid inspector general
 

THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section 1. Subdivision 6 of section 32 of the public  health  law,  as
 added by chapter 442 of the laws of 2006, is amended to read as follows:

 6.  to pursue civil and administrative enforcement actions against any
 individual or entity that engages in fraud, abuse, or illegal or improp
 er acts or unacceptable practices perpetrated within the medical assist
 ance program, including but not limited to: (a) referral of  information
 and  evidence to regulatory agencies and licensure boards; (b) withhold
 ing payment of medical assistance funds in  accordance  with  state  and
 federal laws and regulations; (c) imposition of administrative sanctions
 and penalties in accordance with state and federal laws and regulations;
 (d)  exclusion  of providers, vendors and contractors from participation
 in the program; (e) initiating and maintaining actions for civil  recov
 ery  and,  where  authorized by law, seizure of property or other assets
 connected with improper payments; and entering into  civil  settlements;
 and (f) recovery of improperly expended medical assistance program funds
 from  those  who  engage  in fraud or abuse, or illegal or improper acts
 perpetrated within the medical assistance program.  THE INSPECTOR  SHALL
 NOT  APPLY  ANY  EXTRAPOLATION  METHOD  TO A CATEGORY OF ERROR OR DEFECT
 WITHIN A SAMPLE UNLESS THE INSPECTOR  SHALL  FIRST  DETERMINE  THAT  THE
 CATEGORY  OF ERROR OR DEFECT IN THE BILLING OR OTHER PRACTICE IDENTIFIED
 BY THE INSPECTOR IN THE SAMPLE OF CLAIMS EXCEEDS A RATE OF FIVE  PERCENT
 WITHIN  THE  SAMPLE OF CLAIMS. In the pursuit of such civil and adminis
 trative enforcement actions under this subdivision, the inspector  shall
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD11058-02-1
 
       S. 4806--A                          2
 consider  the  quality and availability of medical care and services and
 the best interest of both the medical assistance program and recipients;
 

S  2. This act shall take effect on the first of January next succeed
 ing the date upon which it shall have become a law and  shall  apply  to
 enforcement actions commenced on or after such date.

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