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H0668.................................................by HEALTH AND WELFARE
MEDICAID FRAUD - Adds to existing law to provide for the investigation and
prosecution of Medicaid fraud by the Office of the Attorney General; to
provide for the adoption of procedures; to provide for the collection of
overpayments; to provide for the employment of necessary personnel; to
provide for reporting; to provide a definition; and to provide for
rulemaking authority.
02/13 House intro - 1st rdg - to printing
02/14 Rpt prt - to Health/Wel
03/13 Rpt out - rec d/p - to 2nd rdg
03/14 2nd rdg - to 3rd rdg
03/15 3rd rdg - PASSED - 62-0-8
AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer,
Bedke, Bell, Bilbao, Black, Block, Boe, Bolz, Brackett, Bradford,
Cannon, Chadderdon, Collins, Deal, Denney, Edmunson, Eskridge,
Field(18), Field(23), Garrett, Hart, Henbest, Henderson, Jaquet,
Kemp, Lake, LeFavour, Loertscher, Martinez, Mathews, McGeachin,
McKague, Miller, Mitchell, Moyle, Nielsen, Nonini, Pasley-Stuart,
Pence, Raybould, Ringo, Roberts, Rusche, Rydalch, Sali, Schaefer,
Shepherd(2), Shepherd(8), Shirley, Skippen, Smith(30), Smith(24),
Smylie, Snodgrass, Stevenson, Trail, Wood
NAYS -- None
Absent and excused -- Clark, Crow, Ellsworth, Harwood, Ring, Sayler,
Wills, Mr. Speaker
Floor Sponsor - Mathews
Title apvd - to Senate
03/16 Senate intro - 1st rdg - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 668
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAID; AMENDING CHAPTER 14, TITLE 67, IDAHO CODE, BY THE ADDI-
3 TION OF A NEW SECTION 67-1404, IDAHO CODE, TO PROVIDE FOR THE INVESTIGA-
4 TION AND PROSECUTION OF MEDICAID FRAUD BY THE OFFICE OF THE ATTORNEY GEN-
5 ERAL, TO PROVIDE FOR THE ADOPTION OF PROCEDURES, TO PROVIDE FOR THE COL-
6 LECTION OF OVERPAYMENTS, TO PROVIDE FOR THE EMPLOYMENT OF NECESSARY PER-
7 SONNEL, TO PROVIDE FOR REPORTING, TO PROVIDE A DEFINITION AND TO PROVIDE
8 FOR RULEMAKING AUTHORITY; AND PROVIDING AN EFFECTIVE DATE.
9 Be It Enacted by the Legislature of the State of Idaho:
10 SECTION 1. That Chapter 14, Title 67, Idaho Code, be, and the same is
11 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
12 ignated as Section 67-1404, Idaho Code, and to read as follows:
13 67-1404. DUTIES OF THE ATTORNEY GENERAL REGARDING MEDICAID FRAUD. (1) The
14 office of the attorney general shall be responsible for conducting a statewide
15 program for the investigation and prosecution of violations of all applicable
16 Idaho laws regarding any and all aspects of fraud in connection with any
17 aspect of the provision of medical assistance pursuant to programs adminis-
18 tered by the department of health and welfare including, but not limited to,
19 medical, dental, optical and mental health medical assistance, the transporta-
20 tion, board and care services related to such medical assistance, and the
21 activities of providers of such medical assistance and services. Further,
22 upon approval of the inspector general of the relevant federal agency, the
23 office of the attorney general shall be responsible for the investigation and
24 prosecutions of violations of any aspect of the provision of health care ser-
25 vices and activities of providers of such services under any federal health
26 care program as defined in 42 U.S.C. section 1320a-7b(f)(1), if the suspected
27 fraud or violation of law in such case or investigation is primarily related
28 to the state plan under subchapter XIX, chapter 7, title 42 U.S.C.
29 (2) In order to carry out its responsibilities under this section, the
30 office of the attorney general shall adopt procedures for:
31 (a) Reviewing complaints of abuse or neglect of patients in health care
32 facilities which receive payment under the state plan under subchapter
33 XIX, chapter 7, title 42 U.S.C.;
34 (b) Reviewing complaints of abuse or neglect of patients residing in
35 board and care facilities; and
36 (c) Acting upon such complaints under the criminal laws of the state of
37 Idaho or for referring such complaints to other state agencies for action.
38 (3) The office of the attorney general shall collect overpayments that
39 are made under the state plan or under any federal health care program to
40 health care facilities and that are discovered by the office of the attorney
41 general in carrying out its responsibilities under this section. All funds
42 collected by the office of the attorney general in accordance with this sub-
43 section (3) shall be credited exclusively to, and available for expenditure
2
1 under, the federal health care program, including the state plan under sub-
2 chapter XIX, chapter 7, title 42 U.S.C., that was subject to the activity that
3 was the basis for the collection.
4 (4) The office of the attorney general shall employ such auditors, attor-
5 neys, investigators and other personnel as are necessary to carry out its
6 responsibilities set forth under this section.
7 (5) The office of the attorney general shall submit to the secretary of
8 the federal department of health and human services applications and reports
9 containing such information as determined by the secretary by regulation to be
10 necessary to meet the requirements of subchapter XIX, chapter 7, title 42
11 U.S.C.
12 (6) For the purpose of this section, "board and care facility" means a
13 residential setting which receives payment from or on behalf of two (2) or
14 more unrelated adults who reside in such facility, and for whom one (1) or
15 more of the following is provided:
16 (a) Nursing care services provided by, or under the supervision of, a
17 registered nurse, licensed practical nurse or licensed nurse assistant.
18 (b) A substantial amount of personal care services that assist residents
19 with the activities of daily living, including personal hygiene, dressing,
20 bathing, eating, toileting, ambulation, transfer, positioning, self-
21 medication, body care, travel to medical services, essential shopping,
22 meal preparation, laundry and housework.
23 Provided however, the board and care facility must be a provider of medicaid
24 services.
25 (7) The attorney general shall have the authority to adopt rules neces-
26 sary to implement the responsibilities assigned to the office of the attorney
27 general under this section.
28 SECTION 2. This act shall be in full force and effect on and after Janu-
29 ary 15, 2007.
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STATEMENT OF PURPOSE
RS 15875
This legislation amends Chapter 14, Title 67 of the Idaho Code to
provide for the investigation and prosecution of medicaid fraud
by the Office of Attorney General. It also outlines the adoption
procedures, collection of overpayments, employment of necessary
personnel, and rulemaking authority.
Medicaid fraud is currently monitored as part of a combined unit
in the Department of Health and Welfare and does not meet the
independence requirements to become federally certified. Idaho
is one of only two States that does not currently have a
Certified Medicaid Fraud Control Unit. The Federal Government
recognizes the need for an independent unit by offering to pay
most of the costs.
FISCAL IMPACT
A separate Medicaid Fraud Control Unit established in the
Attorney General's Office would meet the independence
requirements and allow the Unit to receive a federal grant
program that provides 90% funding for the first three years and
75% funding every year thereafter. The current fraud unit is
funded at 50% federal matching funds.
Existing appropriations for Medicaid fraud investigations within
the Department of Health and Welfare could be transferred to the
Office of Attorney General to provide the necessary matching
funds for the federal grant program.
It is estimated that there will be a fiscal impact of $740,750
for start up and transition costs.
CONTACT
Name: Rep. Russ Mathews
Speaker Bruce Newcomb
Rep. Lawrence Denney
Rep. Mike Moyle
Rep. Julie Ellsworth
Rep. Janice McGeachin
Rep. Margaret Henbest
Phone: (208) 332-1000
STATEMENT OF PURPOSE/FISCAL NOTE H 668