S2554-2013 Actions

• Jan 22, 2013: REFERRED TO HEALTH

S2554-2013 Memo

BILL NUMBER:S2554

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.

S2554-2013 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                    2554

                         2013-2014 Regular Sessions

                              I N  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