NOTE: As provided in LFC policy, this report is
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legislature. The Legislative Finance Committee does not assume
responsibility for the accuracy of the information in this report when used for
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SPONSOR: |
Varela |
DATE TYPED: |
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HB |
668a/HGUAC |
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SHORT TITLE: |
Medicaid Fraud Control Unit |
SB |
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ANALYST: |
Weber |
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APPROPRIATION
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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See Narrative |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Responses
Received From
Attorney
General
Human
Services Department
Department
of Health
SUMMARY
Synopsis of HGUAC
Amendment
The House and Urban Affairs Committee made the
following change to House Bill 668.
On page 6, line 16 after the period the remainder of
the line and all of line 17 and 18 through “unit” is omitted. The omitted line read, “No disposition of any
investigation or settlement of any fraud claim shall be made without the
approval of the unit”. With the omission
of this language, the disposition of claims remains the responsibility of HSD.
Synopsis
of Original Bill
House
Bill 668 (HB 668) requires that the Medicaid Fraud Control Unit (MFCU) develop
a joint protocol concerning investigation of Medicaid fraud with the Human
Services Department (HSD), Children, Youth, Families Department (CYFD), and
Department of Health (DOH). It requires
that HSD, CYFD, DOH, and MFCU enter into a memorandum of understanding (MOU)
concerning coordination and investigation of fraud. The Memorandum of Understanding (MOU) will
require that a report be made to the Legislative Finance Committee (LFC)
concerning the results of all investigations, including the disposition of
recoveries received. Finally, it
requires that MFCU must approve the disposition of any investigation or
settlement of any fraud claim.
Significant
Issues
The Attorney General, on the other hand, feels
this legislation recognizes that there is currently a lack of coordination
between DOH, HSD and the MFCU when conducting investigations involving
allegations of Medicaid provider fraud.
Presently, each agency conducts independent investigations, many times
without the other agency’s knowledge or input.
A Joint Protocol could eliminate duplicative investigations, allowing
the other agencies to pursue different matters.
The legislation also contains two provisions for
reporting to the Legislative Finance Committee on a quarterly basis. The key provision is that all settlement
agreements must be approved by the Attorney General’s Office suggests that a
significant problem currently exists regarding fraud case dispositions.
These two agency’s responses suggest there is a
difference of perspective based on what each portrays as its role in the
process. HSD has indicated its desire to
arrange financial settlements in some cases, while the Attorney General may
want to pursue an investigation criminally.
This inherent difference suggests closer co-operation may be necessary. HSD refers to, but does not define, the
violation of federal law. This may
relate to HSD’s role as primary Medicaid contact for
the state leaving the agency as final arbiter among agencies.
FISCAL IMPLICATIONS
There is no
appropriation but the mechanics of operating such a unit may require additional
funds.
ADMINISTRATIVE IMPLICATIONS
There would be
administrative work required to set up and maintain such a unit.
OTHER SUBSTANTIVE ISSUES
The new section
requires that “No disposition of any investigation or settlement of any fraud
claim shall be made without the approval of the unit”. However, how approval is reached is not
defined.
MW/ls:sb