Relates to enforcement actions by the office of the Medicaid inspector general.
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: 2011-12: S. 4806-A: Referred to Health
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: This act shall take effect next succeeding January, and apply to enforcement actions commenced on or after such date.
STATE OF NEW YORK ________________________________________________________________________ 2554 2013-2014 Regular Sessions IN SENATE January 22, 2013 ___________Introduced by Sen. MARCELLINO -- read twice and ordered printed, and when printed to be committed to the Committee on Health 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 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.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07234-01-3