S2609-2011 Actions

• Jan 26, 2011: REFERRED TO FINANCE

S2609-2011 Memo

BILL NUMBER:S2609

TITLE OF BILL:

An act
to amend the executive law, in relation to establishing the office
of Empire Blue Cross and Blue Shield inspector general

SUMMARY:

This bill would add a new section 75 to the Executive Law and create
the office of the Empire Blue Cross and Blue Shield Inspector General
within the Office of the Deputy Attorney General for Medicaid Fraud
Control.
The Blue Cross and Blue Shield Inspector General shall be empowered
to investigate the activities of and prosecute fraud, abuse or
illegal acts perpetrated by Empire Blue Cross and Blue Shield.

JUSTIFICATION:

The rising cost of health care in our state has been partly linked to
alleged fraud in the delivery system. This bill created an office to
investigate the activities of Blue Cross and Blue Shield and thereby
alleviate any strain to consumers due to illegal activity.

FISCAL IMPLICATIONS:

Not been determined.

EFFECTIVE DATE:

This act shall take effect immediately.

S2609-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                         2609
 2011-2012 Regular Sessions
 I N  SENATE
 January 26, 2011
 
 Introduced  by  Sen.  KRUGER -- read twice and ordered printed, and when
 printed to be committed to the Committee on Finance
 

AN ACT to amend the executive  law,  in  relation  to  establishing  the
 office of Empire Blue Cross and Blue Shield inspector general
 

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

 

Section 1. The executive law is amended by adding a new section 75  to
 read as follows:

 

S  75.  EMPIRE BLUE CROSS AND BLUE SHIELD INSPECTOR GENERAL. 1.  DEFI
 NITIONS. FOR THE PURPOSES OF THIS  SECTION,  THE  FOLLOWING  DEFINITIONS
 SHALL APPLY:

 A.  "INSPECTOR"  MEANS THE EMPIRE BLUE CROSS AND BLUE SHIELD INSPECTOR
 GENERAL CREATED BY THIS SECTION.
 B. "INVESTIGATION" MEANS, INVESTIGATIONS OF FRAUD, ABUSE,  OR  ILLEGAL
 ACTS PERPETRATED WITHIN EMPIRE BLUE CROSS AND BLUE SHIELD.
 C. "OFFICE" MEANS THE OFFICE OF THE  EMPIRE BLUE CROSS AND BLUE SHIELD
 INSPECTOR GENERAL CREATED BY THIS SECTION.
 2.  OFFICE  OF  EMPIRE  BLUE  CROSS AND BLUE SHIELD INSPECTOR GENERAL;
 CREATION.  A. THERE IS HEREBY CREATED IN THE DEPARTMENT  OF  LAW  WITHIN
 THE  OFFICE OF THE DEPUTY ATTORNEY GENERAL FOR MEDICAID FRAUD CONTROL AN
 OFFICE OF THE EMPIRE BLUE CROSS AND BLUE SHIELD INSPECTOR  GENERAL.  THE
 HEAD  OF  THE  OFFICE  SHALL  BE THE   EMPIRE BLUE CROSS AND BLUE SHIELD
 INSPECTOR GENERAL, WHO SHALL BE APPOINTED BY THE GOVERNOR, BY  AND  WITH
 THE ADVICE AND CONSENT OF THE SENATE.
 B.  THE  INSPECTOR SHALL SERVE FOR A TERM OF FIVE YEARS UNLESS REMOVED
 BY THE GOVERNOR FOR NEGLECT OR MALFEASANCE IN OFFICE, AND  MAY  ALSO  BE
 REMOVED  FOR  NEGLECT  OR  MALFEASANCE  BY  THE  SENATE  UPON  A VOTE OF
 TWO-THIRDS OF ITS MEMBERS. AN INSPECTOR REMOVED FROM OFFICE MAY  NOT  BE
 REAPPOINTED TO SUCH OFFICE.
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD07245-01-1
 
       S. 2609                             2
 C.  THE INSPECTOR MAY NOT BE EMPLOYED WITH THE DEPARTMENT OF INSURANCE
 DURING HIS OR HER EMPLOYMENT WITH THE OFFICE OR WITHIN TWO  YEARS  AFTER
 TERMINATING EMPLOYMENT WITH THE OFFICE.
 3.  FUNCTIONS,  DUTIES  AND RESPONSIBILITIES. THE INSPECTOR SHALL HAVE
 THE FOLLOWING FUNCTIONS, DUTIES AND RESPONSIBILITIES:

 A. TO APPOINT SUCH DEPUTIES, DIRECTORS, ASSISTANTS AND OTHER  OFFICERS
 AND  EMPLOYEES AS MAY BE NEEDED FOR THE PERFORMANCE OF HIS OR HER DUTIES
 AND MAY PRESCRIBE THEIR POWERS AND FIX  THEIR  COMPENSATION  WITHIN  THE
 AMOUNTS APPROPRIATED THEREFOR;
 B. TO CONDUCT AND SUPERVISE INVESTIGATIONS OF THE ACTIVITIES OF EMPIRE
 BLUE  CROSS  AND  BLUE  SHIELD  AND, TO THE GREATEST EXTENT POSSIBLE, TO
 COORDINATE  WITH THE SUPERINTENDENT OF INSURANCE;
 C.  TO KEEP THE GOVERNOR, ATTORNEY  GENERAL,  STATE  COMPTROLLER,  THE
 TEMPORARY  PRESIDENT AND  MINORITY LEADER OF THE SENATE, THE SPEAKER AND
 THE MINORITY AND MAJORITY LEADERS OF THE ASSEMBLY, APPRISED OF FRAUD AND
 ABUSE;
 D. TO PROSECUTE FRAUD, ABUSE OR ILLEGAL ACTS PERPETRATED WITHIN EMPIRE
 BLUE CROSS AND BLUE SHIELD;
 E. TO MAKE INFORMATION AND EVIDENCE RELATING TO CRIMINAL ACTS WHICH HE
 OR SHE MAY OBTAIN IN CARRYING OUT HIS OR HER DUTIES AVAILABLE TO  APPRO
 PRIATE LAW ENFORCEMENT OFFICIALS AND LOCAL DISTRICT ATTORNEYS TO COORDI
 NATE INVESTIGATIONS AND CRIMINAL PROSECUTIONS;
 F.  TO  SUBPOENA  WITNESSES,  ADMINISTER  OATHS  OR AFFIRMATIONS, TAKE
 TESTIMONY AND COMPEL THE PRODUCTION OF SUCH BOOKS, PAPERS,  RECORDS  AND
 DOCUMENTS  AS  HE  OR  SHE  MAY  DEEM TO BE RELEVANT TO AN INVESTIGATION
 UNDERTAKEN PURSUANT TO THIS SECTION;
 G. TO MONITOR THE IMPLEMENTATION BY THE RELEVANT OFFICE OF HIS OR  HER
 RECOMMENDATIONS AND THOSE OF OTHER INVESTIGATIVE AGENCIES;
 H.  TO  RECOMMEND POLICIES RELATING TO THE PREVENTION AND DETECTION OF
 FRAUD AND ABUSE OR THE IDENTIFICATION AND PROSECUTION OF PARTICIPANTS IN
 SUCH FRAUD OR ABUSE; AND
 I. TO RECEIVE COMPLAINTS OF ALLEGED FAILURES OF STATE AND LOCAL  OFFI
 CIALS TO PREVENT, DETECT AND PROSECUTE FRAUD AND ABUSE.
 4.  COOPERATION  OF  AGENCY OFFICIALS AND EMPLOYEES. A. IN ADDITION TO
 THE AUTHORITY OTHERWISE PROVIDED BY  THIS  SECTION,  THE  INSPECTOR,  IN
 CARRYING OUT THE PROVISIONS OF THIS SECTION, IS AUTHORIZED:

 (I)  TO  HAVE  FULL  AND  UNRESTRICTED ACCESS TO ALL RECORDS, REPORTS,
 AUDITS, REVIEWS, DOCUMENTS, PAPERS, RECOMMENDATIONS  OR  OTHER  MATERIAL
 AVAILABLE  TO THE DEPARTMENT OF INSURANCE RELATING TO PROGRAMS AND OPER
 ATIONS WITH RESPECT TO WHICH THE INSPECTOR  HAS  RESPONSIBILITIES  UNDER
 THIS SECTION;
 (II) TO MAKE SUCH INVESTIGATIONS RELATING TO THE ADMINISTRATION OF THE
 PROGRAMS  AND  OPERATIONS  OF THE DEPARTMENT OF INSURANCE AS ARE, IN THE
 JUDGMENT OF THE INSPECTOR, NECESSARY OR DESIRABLE; AND
 (III) TO REQUEST SUCH INFORMATION, ASSISTANCE AND COOPERATION FROM ANY
 FEDERAL, STATE OR LOCAL GOVERNMENTAL DEPARTMENT, BOARD, BUREAU,  COMMIS
 SION,  OR  OTHER AGENCY OR UNIT THEREOF AS MAY BE NECESSARY FOR CARRYING
 OUT THE DUTIES AND RESPONSIBILITIES ENJOINED UPON HIM  OR  HER  BY  THIS
 SECTION. STATE AND LOCAL AGENCIES OR UNITS THEREOF ARE HEREBY AUTHORIZED
 AND DIRECTED TO PROVIDE SUCH INFORMATION, ASSISTANCE AND COOPERATION.
 B.  NOTWITHSTANDING  ANY OTHER PROVISION OF LAW, RULE OR REGULATION TO
 THE CONTRARY, NO PERSON SHALL PREVENT, SEEK TO PREVENT, INTERFERE  WITH,
 OBSTRUCT  OR OTHERWISE HINDER ANY INVESTIGATION BEING CONDUCTED PURSUANT
 TO THIS SECTION. ANY VIOLATION OF THIS PARAGRAPH SHALL CONSTITUTE  CAUSE
 FOR SUSPENSION OR REMOVAL FROM OFFICE OR EMPLOYMENT.
 
       S. 2609                             3
 5.  ESTABLISHMENT  PERIOD.  THE  GOVERNOR  SHALL  NOMINATE THE INITIAL
 INSPECTOR AS SOON AS IS PRACTICABLE BUT IN NO  EVENT  LATER  THAN  SIXTY
 DAYS AFTER THE EFFECTIVE DATE OF THIS SECTION.
 6.  REPORTS  REQUIRED  OF THE INSPECTOR. THE INSPECTOR SHALL, NO LATER
 THAN FEBRUARY FIRST OF EACH YEAR, SUBMIT  TO  THE  GOVERNOR,  THE  STATE
 COMPTROLLER, THE ATTORNEY GENERAL AND THE LEGISLATURE A REPORT SUMMARIZ
 ING THE ACTIVITIES OF THE OFFICE DURING THE PRECEDING CALENDAR YEAR.
 7.  DISCLOSURE  OF  INFORMATION.  A.  THE INSPECTOR SHALL NOT PUBLICLY
 DISCLOSE INFORMATION WHICH IS:

 (I) A PART OF ANY ONGOING INVESTIGATION; OR
 (II) SPECIFICALLY PROHIBITED FROM DISCLOSURE BY ANY OTHER PROVISION OF
 LAW.
 B. NOTWITHSTANDING PARAGRAPH A OF THIS SUBDIVISION, ANY  REPORT  UNDER
 THIS  SECTION  MAY  BE  DISCLOSED TO THE PUBLIC IN A FORM WHICH INCLUDES
 INFORMATION WITH RESPECT TO A PART OF AN ONGOING CRIMINAL  INVESTIGATION
 IF SUCH INFORMATION HAS BEEN INCLUDED IN A PUBLIC RECORD.
 

S 2. This act shall take effect immediately.

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