Creates incentives for counties to investigate and prosecute medicaid fraud.
TITLE OF BILL: An act to amend the social services law, in relation to creating incentives for counties to investigate and prosecute medicaid fraud
PURPOSE: The purpose of this bill is to provide financial incentives to the City of New York and the counties to identify and prosecute Medicaid fraud, thereby helping eliminate fraud, waste and abuse.
SUMMARY OF PROVISIONS: The social services law is amended by adding a new article 5-A and amending subdivision 2 of section 145-b to enable the City of New York and the counties to keep 100% of the local share of any successful Medicaid fraud prosecution, or 10% of the recovery, whichever is greater.
JUSTIFICATION: It is essential to minimize any waste, fraud or abuse in the Medicaid system by encouraging and rewarding successful efforts by the City of New York and the counties to prosecute Medicaid fraud.
The current law limits the amounts that local governments can receive based on successful Medicaid fraud prosecution. This bill would ensure that local governments would receive 100% of the local share of such Medicaid payments, thereby reimbursing the local governments in full for the original overpayment. Since the local share on some programs may be very small, the local governments would be guaranteed at least 10% of any recovery. The State would receive the balance of recoveries.
By encouraging more Medicaid fraud prosecutions, the total costs of the system will be reduced, to the benefit of both the State and local governments. The State, of course, would be the biggest beneficiary of the reduction in the amount of fraud and abuse because it pays a substantially higher percentage of Medicaid costs than the local governments.
This legislation is particularly important because the existing Medicaid payment cap that applies to local governments inadvertently reduced the financial incentive for local governments to root out fraud, waste and abuse. Under the cap legislation, the cost to local governments is automatically determined by the amount specified by the cap rather than being based on actual costs. This bill would restore the financial incentive to local governments by enabling them to enjoy 100% of the local share of any savings resulting from successful Medicaid fraud prosecutions.
LEGISLATIVE HISTORY: 2012: S.6881/A.9494 Passed Senate
FISCAL IMPLICATIONS: This bill allows the city of New York and the counties to recoup 100%
of the local share upon the successful prosecution of Medicaid fraud, or at 10% whichever is greater.
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 2617 2013-2014 Regular Sessions IN SENATE January 23, 2013 ___________Introduced by Sens. YOUNG, GALLIVAN -- read twice and ordered printed, and when printed to be committed to the Committee on Social Services AN ACT to amend the social services law, in relation to creating incen- tives for counties to investigate and prosecute medicaid fraud THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The social services law is amended by adding a new article 5-A to read as follows: ARTICLE 5-A MEDICAID FRAUD REIMBURSEMENT SECTION 370-BB. DISPOSITION OF MONEYS RECEIVED AS THE RESULT OF THE PROSECUTION OF MEDICAID FRAUD. S 370-BB. DISPOSITION OF MONEYS RECEIVED AS THE RESULT OF THE PROSE- CUTION OF MEDICAID FRAUD. 1. FOR THE PURPOSES OF THIS SECTION, "MEDICAID FRAUD" SHALL MEAN THE KNOWING COMMISSION OF ANY CRIME WITH INTENT TO ILLEGALLY RECEIVE BENEFITS, OR REIMBURSEMENT FROM THE MEDICAL ASSISTANCE FOR NEEDY PERSONS PROGRAM ESTABLISHED AND ADMINISTERED PURSUANT TO THIS CHAPTER, THE PUBLIC HEALTH LAW AND FEDERAL LAW. 2. SHOULD ANY COUNTY OR THE CITY OF NEW YORK SUCCESSFULLY PROSECUTE ANY CASE FOR MEDICAID FRAUD AND A COURT AWARDS RESTITUTION OR CIVIL FORFEITURE, THE FOLLOWING PORTION OF THE NON-FEDERAL SHARE OF THE PROCEEDS OF SUCH RESTITUTION OR CIVIL FORFEITURE SHALL BE ALLOCATED AS FOLLOWS: (I) THE COUNTY OR THE CITY OF NEW YORK SHALL RECEIVE ONE HUNDRED PERCENT OF THE LOCAL SHARE OF SUCH FUNDS, IN EFFECT IMMEDIATELY PRIOR TO SUCH DATE AS CERTIFIED BY THE DIVISION OF BUDGET OR TEN PERCENT OF THE TOTAL RECOVERY WHICHEVER NUMBER IS GREATER; (II) THE REMAINDER THEREOF SHALL BE DEPOSITED INTO THE GENERAL FUND OF THE STATE.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07129-01-3 S. 2617 2
3. NOTHING IN THIS ARTICLE SHALL IMPAIR ANY COUNTY OR THE CITY OF NEW YORK'S ABILITY TO SEEK DAMAGES UNDER SECTION ONE HUNDRED FORTY-FIVE-B OF THIS CHAPTER. S 2. Paragraph (a) of subdivision 2 of section 145-b of the social services law, as amended by chapter 109 of the laws of 2007, is amended to read as follows: (a) For civil damages collected by a local social services district, relating to the medical assistance program, pursuant to a judgment under this subdivision, such amounts shall be apportioned between the local social services district and the state.
[If the violation occurred: (i) prior to January first, two thousand six, the]THE amount apportioned to the local social services district shall be ONE HUNDRED PERCENT OF the local share [percentage]OF SUCH FUNDS, in effect immediately prior to such date as certified by the division of budget [, or (ii) after January first, two thousand six, the amount apportioned to the local social services district shall be based on a reimbursement schedule, created by the office of Medicaid inspector general, in effect at the time the violation occurred; provided that, if there is no schedule in effect at the time the violation occurred, the schedule to be used shall be the first schedule adopted pursuant to this subdivision. Such schedule shall provide for reimbursement to a local social services district in an amount between ten and fifteen percent of the gross amount collected. Such schedule shall be set on a county by county basis and shall be periodically reviewed and updated as necessary; provided, however, that any such updated schedule shall not be less than ten percent nor greater than fifteen percent of the gross amount collected]OR TEN PERCENT OF THE TOTAL RECOVERY WHICHEVER NUMBER IS GREATER; and S 3. This act shall take effect immediately.