Relates to creating incentives for counties to investigate and prosecute medicaid fraud.

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S6881-2011 Actions

• Jun 19, 2012: referred to health
• Jun 19, 2012: DELIVERED TO ASSEMBLY
• Jun 19, 2012: PASSED SENATE
• Jun 19, 2012: ORDERED TO THIRD READING CAL.1362
• Jun 19, 2012: COMMITTEE DISCHARGED AND COMMITTED TO RULES
• May 22, 2012: REPORTED AND COMMITTED TO FINANCE
• Apr 4, 2012: REFERRED TO SOCIAL SERVICES

S6881-2011 Meetings

Social Services: May 22, 2012, Rules: Jun 21, 2012

S6881-2011 Calendars

Floor Calendar: Jun 19, 2012

S6881-2011 Votes

S6881-2011 Memo

BILL NUMBER:S6881

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
t pays a substantially higher percentage of Medicaid costs that 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:
New bill.

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.

S6881-2011 Text

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

                                    6881

                              I N  SENATE

                                April 4, 2012
                                 ___________

  Introduced  by  Sen.  YOUNG  -- 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  THE
  SOCIAL SERVICES LAW, 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.
    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
  THE SOCIAL SERVICES LAW.

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD14839-03-2

 S. 6881                             2

    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.