View Bill Status
View Bill Text
View Amendment
View Engrossed Bill (Original Bill with Amendment(s) Incorporated)
View Statement of Purpose / Fiscal Impact
H0166aa,aaS...........................................by HEALTH AND WELFARE
MEDICAID FRAUD CONTROL UNIT - Amends and adds to existing law to provide
for a Medicaid Fraud Program in the Department of Health and Welfare; to
provide referral and compliance requirements; to provide for a minimum for
cost recovery; to provide for record retention requirements; to provide for
criminal penalties; to establish in the Office of the Attorney General the
Medicaid Fraud Control Unit; to provide for costs and reasonable attorney's
fees; to require persons asking to be excused from attending, producing or
testifying on the grounds of self-incrimination to comply with the request;
to provide for the use of information provided by persons privileged to
withhold information; to provide authority to the attorney general and any
prosecuting attorney to issue subpoenas and compel testimony from
custodians; to provide peace officer status to investigators employed by
the attorney general; and to revise duties of the attorney general.
02/09 House intro - 1st rdg - to printing
02/12 Rpt prt - to Health/Wel
02/21 Rpt out - to Gen Ord
02/22 Rpt out amen - to engros
02/23 Rpt engros - 1st rdg - to 2nd rdg as amen
02/26 2nd rdg - to 3rd rdg as amen
02/28 3rd rdg as amen - PASSED - 69-0-1
AYES -- Anderson, Andrus, Barrett, Bayer, Bedke, Bell, Bilbao, Black,
Block, Bock, Boe, Bolz, Brackett, Bradford, Chadderdon, Chavez, Chew,
Clark, Collins, Crane, Durst, Edmunson, Eskridge, Hagedorn, Hart,
Harwood, Henbest, Henderson, Jaquet, Killen, King, Kren, Labrador,
Lake, LeFavour, Loertscher, Luker, Marriott, Mathews, McGeachin,
Mortimer, Moyle, Nielsen, Nonini, Pasley-Stuart, Patrick, Pence,
Raybould, Ring, Ringo, Ruchti, Rusche, Sayler, Schaefer, Shepherd(2),
Shepherd(8), Shirley, Shively, Smith(30), Smith(24), Snodgrass,
Stevenson, Thayn, Trail, Vander Woude, Wills, Wood(27), Wood(35), Mr.
Speaker
NAYS -- None
Absent and excused -- Roberts
Floor Sponsor - Mathews
Title apvd - to Senate
03/01 Senate intro - 1st rdg - to Health/Wel
03/08 Rpt out - rec d/p - to 2nd rdg
03/09 2nd rdg - to 3rd rdg
03/15 To 14th Ord
03/16 Rpt out amen - to 1st rdg as amen
03/19 1st rdg - to 2nd rdg as amen
Rls susp - PASSED - 32-0-3
AYES -- Andreason, Bair, Bastian, Bilyeu, Broadsword, Burkett,
Cameron, Coiner, Corder, Darrington, Davis, Fulcher, Geddes, Goedde,
Hammond, Heinrich, Hill, Jorgenson, Kelly, Keough, Langhorst, Little,
Lodge, McGee, McKague, McKenzie, Pearce, Richardson, Schroeder,
Siddoway, Stegner, Werk
NAYS -- None
Absent and excused -- Gannon, Malepeai, Stennett
Floor Sponsors - Lodge, Cameron & McGee
Title apvd - to House
03/20 House concurred in Senate amens - to engros
03/21 Rpt engros - 1st rdg - to 2nd rdg as amen
03/22 2nd rdg - to 3rd rdg as amen
03/26 3rd rdg as amen - PASSED - 68-0-2
AYES -- Andrus, Barrett, Bayer, Bedke, Bell, Bilbao, Black, Block,
Bock, Boe, Bolz, Brackett, Bradford, Chadderdon, Chavez, Chew, Clark,
Collins, Crane, Durst, Eskridge, Hagedorn, Hart, Harwood, Henbest,
Henderson, Jaquet, Killen, King, Kren, Labrador, Lake, LeFavour,
Loertscher, Luker, Marriott, Mathews, McGeachin, Mortimer, Moyle,
Nielsen, Nonini, Pasley-Stuart, Patrick, Pence, Raybould, Ring,
Ringo, Roberts, Ruchti, Rusche, Sayler, Schaefer, Shepherd(2),
Shepherd(8), Shirley, Shively, Smith(30), Smith(24), Snodgrass,
Stevenson, Thayn, Trail, Vander Woude, Wills, Wood(27), Wood(35), Mr.
Speaker
NAYS -- None
Absent and excused -- Anderson, Edmunson
Floor Sponsor - Mathews
Title apvd - to enrol
03/27 Rpt enrol - Sp signed
03/28 Pres signed - To Governor
04/02 Governor signed
Session Law Chapter 341
Effective: 07/01/07
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 166
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAID; AMENDING SECTION 15-8-103, IDAHO CODE, TO MAKE A TECHNI-
3 CAL CORRECTION; AMENDING SECTION 56-209h, IDAHO CODE, TO DEFINE A TERM, TO
4 PROVIDE FOR A MEDICAID FRAUD PROGRAM IN THE DEPARTMENT OF HEALTH AND WEL-
5 FARE AND THE SCOPE OF SUCH PROGRAM, TO REMOVE A TIME REQUIREMENT, TO
6 REMOVE A CONDITION FOR ACTION, TO PROVIDE FOR ACTION UPON REFERRAL, TO
7 PROVIDE REFERRAL AND COMPLIANCE REQUIREMENTS, TO PROVIDE FOR A MINIMUM FOR
8 COST RECOVERY AND TO MAKE A TECHNICAL CORRECTION; AMENDING CHAPTER 2,
9 TITLE 56, IDAHO CODE, BY THE ADDITION OF NEW SECTIONS 56-209o AND 56-226,
10 IDAHO CODE, TO PROVIDE FOR RECORD RETENTION REQUIREMENTS, TO PROVIDE FOR
11 CRIMINAL PENALTIES, TO ESTABLISH IN THE OFFICE OF THE ATTORNEY GENERAL THE
12 MEDICAID FRAUD CONTROL UNIT, TO PROVIDE THE DUTIES, AUTHORITY AND RESPON-
13 SIBILITIES OF THE UNIT, TO PROVIDE EXCLUSIVE CONTROL OF THE UNIT AND TO
14 DEFINE TERMS; AMENDING SECTION 56-227, IDAHO CODE, TO REMOVE A REQUIREMENT
15 FOR THE DEPARTMENT OF HEALTH AND WELFARE TO ESTABLISH AND OPERATE A FRAUD
16 CONTROL PROGRAM; AMENDING SECTION 56-227B, IDAHO CODE, TO PROVIDE FOR THE
17 RIGHT OF THE ATTORNEY GENERAL TO CAUSE CERTAIN LEGAL ACTION TO BE UNDER-
18 TAKEN, TO PROVIDE FOR COSTS AND REASONABLE ATTORNEY'S FEES TO BE AWARDED
19 TO THE PREVAILING PARTY, TO PROVIDE FOR THE DISPOSITION OF COSTS AND
20 ATTORNEY'S FEES AND TO MAKE A TECHNICAL CORRECTION; AMENDING SECTION
21 56-227C, IDAHO CODE, TO REQUIRE PERSONS ASKING TO BE EXCUSED FROM ATTEND-
22 ING, PRODUCING OR TESTIFYING ON THE GROUNDS OF SELF-INCRIMINATION TO COM-
23 PLY WITH THE REQUEST, TO PROVIDE FOR THE USE OF INFORMATION PROVIDED BY
24 PERSONS PRIVILEGED TO WITHHOLD INFORMATION, TO PROVIDE AUTHORITY TO THE
25 ATTORNEY GENERAL AND ANY PROSECUTING ATTORNEY TO ISSUE SUBPOENAS AND COM-
26 PEL TESTIMONY FROM CUSTODIANS, TO PROVIDE SUBPOENA REQUIREMENTS, TO PRO-
27 VIDE PROCEDURE AND GROUNDS FOR MODIFYING OR QUASHING A SUBPOENA AND TO
28 PROVIDE PEACE OFFICER STATUS TO INVESTIGATORS EMPLOYED BY THE ATTORNEY
29 GENERAL; AMENDING SECTION 56-227D, IDAHO CODE, TO PROVIDE ENFORCEMENT
30 AUTHORITY TO THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WELFARE, TO PRO-
31 VIDE THAT SUCH ENFORCEMENT IS NOT THE RESPONSIBILITY OF THE MEDICAID FRAUD
32 UNIT AND TO MAKE TECHNICAL CORRECTIONS; AMENDING CHAPTER 2, TITLE 56,
33 IDAHO CODE, BY THE ADDITION OF A NEW SECTION 56-227E, IDAHO CODE, TO PRO-
34 VIDE A DESCRIPTION OF OBSTRUCTION OF INVESTIGATION AND TO PROVIDE CRIMINAL
35 PENALTIES; AND AMENDING SECTION 67-1401, IDAHO CODE, TO REVISE DUTIES OF
36 THE ATTORNEY GENERAL AND TO MAKE TECHNICAL CORRECTIONS.
37 Be It Enacted by the Legislature of the State of Idaho:
38 SECTION 1. That Section 15-8-103, Idaho Code, be, and the same is hereby
39 amended to read as follows:
40 15-8-103. DEFINITIONS. The definitions in this section apply throughout
41 this chapter unless the context clearly requires otherwise:
42 (1) "Matter" includes any issue, question or dispute involving:
43 (a) The determination of any class of creditors, devisees, legatees,
2
1 heirs, next of kin, or other persons interested in an estate, trust,
2 nonprobate asset, or with respect to any other asset or property interest
3 passing at death;
4 (b) The direction of a personal representative or trustee to do or to
5 abstain from doing any act in a fiduciary capacity;
6 (c) The determination of any question arising in the administration of an
7 estate or trust, or with respect to any nonprobate asset, or with respect
8 to any other asset or property interest passing at death, that may
9 include, without limitation, questions relating to:
10 (i) The construction of wills, trusts, devolution agreements, and
11 other writings;
12 (ii) A change of personal representative or trustee;
13 (iii) A change of the situs of a trust;
14 (iv) An accounting from a personal representative or trustee; or
15 (v) The determination of fees for a personal representative or
16 trustee;
17 (d) The grant to a personal representative or trustee of any necessary or
18 desirable power not otherwise granted in the governing instrument or given
19 by law;
20 (e) The amendment, reformation, or conformation of a will or a trust
21 instrument to comply with statutes and regulations of the United States
22 internal revenue service in order to more efficiently allocate exemptions
23 or to achieve qualification for deductions, elections, and other tax
24 requirements including, but not limited to, the qualification of any gift
25 thereunder for the benefit of a surviving spouse who is not a citizen of
26 the United States for the estate tax marital deduction permitted by fed-
27 eral law, including the addition of mandatory governing instrument
28 requirements for a qualified domestic trust under section 2056A of the
29 Internal Revenue Code, the qualification of any gift thereunder as a qual-
30 ified conservation easement as permitted by federal law, or the qualifica-
31 tion of any gift for the charitable estate tax deduction permitted by fed-
32 eral law, including the addition of mandatory governing instrument
33 requirements for a charitable remainder trust; and
34 (f) With respect to any nonprobate asset, or with respect to any other
35 asset or property interest passing at death, including actual joint ten-
36 ancy property, property subject to a devolution agreement, or assets sub-
37 ject to a pay on death or transfer on death designation:
38 (i) The ascertaining of any class of creditors or others for pur-
39 poses of section 15-6-107, Idaho Code;
40 (ii) The ordering of a custodian of any of the decedent's records
41 relating to a nonprobate asset to do or abstain from doing any par-
42 ticular act with respect to those records;
43 (iii) The determination of any question arising in the administration
44 of a nonprobate asset under section 15-6-107, Idaho Code;
45 (iv) The determination of any questions relating to the abatement,
46 rights of creditors, or other matter relating to the administration,
47 settlement, or final disposition of a nonprobate asset under title
48 15, Idaho Code; and
49 (v) The resolution of any matter referencing this chapter, includ-
50 ing a determination of any questions relating to the ownership or
51 distribution of an individual retirement account on the death of the
52 spouse of the account holder as contemplated by section 11-604A(6),
53 Idaho Code;
54 (g) The resolution of any other matter that could affect the nonprobate
55 asset.
3
1 (2) "Nonprobate assets" means assets that are covered by chapter 6, title
2 15, Idaho Code.
3 (3) "Party" or "parties" means each of the following persons who has an
4 interest in the subject of the particular proceeding and whose name and
5 address are known to, or are reasonably ascertainable by, the petitioner:
6 (a) The trustor if living;
7 (b) The trustee;
8 (c) The personal representative;
9 (d) An heir;
10 (e) A beneficiary, including devisees, legatees, and trust beneficiaries;
11 (f) The surviving spouse of a decedent with respect to his or her inter-
12 est in the decedent's property;
13 (g) A guardian ad litem;
14 (h) A creditor;
15 (i) Any other person who has an interest in the subject of the particular
16 proceeding;
17 (j) The attorney general if required under section 67-1401(5.), Idaho
18 Code;
19 (k) Any duly appointed and acting legal representative of a party such as
20 a guardian, conservator, special representative, or attorney in fact;
21 (l) Where applicable, the virtual representative of any person described
22 in this subsection (3), the giving of notice to whom would meet notice
23 requirements as provided in section 15-8-204, Idaho Code; and
24 (m) The owner or the personal representative of the estate of the
25 deceased owner of the nonprobate asset that is the subject of the particu-
26 lar proceeding, if the subject of the particular proceeding relates to the
27 beneficiary's liability to a decedent's estate or creditors under section
28 15-6-107, Idaho Code.
29 (4) "Persons interested in the estate or trust" means the trustor, if
30 living, all persons beneficially interested in the estate or trust, persons
31 holding powers over the trust or estate assets, the attorney general in the
32 case of any charitable trust where the attorney general would be a necessary
33 party to judicial proceedings concerning the trust, and any personal represen-
34 tative or trustee of the estate or trust.
35 (5) "Representative" and other similar terms refer to a person who virtu-
36 ally represents another person under section 15-8-205, Idaho Code.
37 (6) "Trustee" means any acting and qualified trustee of the trust.
38 SECTION 2. That Section 56-209h, Idaho Code, be, and the same is hereby
39 amended to read as follows:
40 56-209h. ADMINISTRATIVE REMEDIES. (1) Definitions. For purposes of this
41 section:
42 (a) "Abuse" or "abusive" means provider practices that are inconsistent
43 with sound fiscal, business, or medical practices, and result in an unnec-
44 essary cost to the medical assistance program, in reimbursement for ser-
45 vices that are not medically necessary or that fail to meet professionally
46 recognized standards for health care, or in physical harm, pain or mental
47 anguish to a medical assistance recipient.
48 (b) "Claim" means any request or demand for payment of items or services
49 under the state's medical assistance program, whether under a contract or
50 otherwise.
51 (c) "Fraud" or "Ffraudulent" means an intentional deception or misrepre-
52 sentation made by a person with the knowledge that the deception could
53 result in some unauthorized benefit to himself or some other person.
4
1 (d) "Knowingly," "known" or "with knowledge" means that a person, with
2 respect to information or an action:
3 (i) Has actual knowledge of the information or action; or
4 (ii) Acts in deliberate ignorance of the truth or falsity of the
5 information or the correctness or incorrectness of the action; or
6 (iii) Acts in reckless disregard of the truth or falsity of the
7 information or the correctness or incorrectness of the action.
8 (e) "Managing employee" means a general manager, business manager, admin-
9 istrator, director or other individual who exercises operational or mana-
10 gerial control over, or who directly or indirectly conducts the day-to-day
11 operation of, an institution, organization or agency.
12 (f) "Medicaid fraud control unit" means that medicaid fraud control unit
13 as provided for in section 56-226, Idaho Code.
14 (g) "Ownership or control interest" means a person or entity that:
15 (i) Has an ownership interest totaling twenty-five percent (25%) or
16 more in an entity; or
17 (ii) Is an officer or director of an entity that is organized as a
18 corporation; or
19 (iii) Is a partner in an entity that is organized as a partnership;
20 or
21 (iv) Is a managing member in an entity that is organized as a lim-
22 ited liability company.
23 (2) The department shall establish and operate an administrative fraud
24 control program to enforce violations of the provisions of this chapter and of
25 the state plan pursuant to subchapters XIX and XXI, chapter 7, title 42,
26 U.S.C., that are outside the scope of the duties of the medicaid fraud control
27 unit and to render and receive referrals from and to said unit.
28 (3) Review of dDocumentation of services. All claims submitted by
29 providers for payment are subject to prepayment and postpayment review as des-
30 ignated by rule. Except as otherwise provided by rule, providers shall gener-
31 ate documentation at the time of service sufficient to support each claim. and
32 shall retain the documentation for a minimum of five (5) years from the date
33 the item or service was provided. The department or authorized agent shall be
34 given immediate access to such documentation upon written request.
35 (34) Immediate action. In the event that the department identifies a sus-
36 pected case of fraud or abuse, and the department has reason to believe that
37 payments made during the investigation may be difficult or impractical to
38 recover, the department may suspend or withhold payments to the provider pend-
39 ing investigation. In the event that the department identifies a suspected
40 case of fraud or abuse and it determines that it is necessary to prevent or
41 avoid immediate danger to the public health or safety, the department may sum-
42 marily suspend a provider agreement pending investigation. When payments have
43 been suspended or withheld or a provider agreement suspended pending investi-
44 gation, the department shall provide for a hearing within thirty (30) days of
45 receipt of any duly filed notice of appeal.
46 (45) Recovery of payments. Upon referral of a matter from the medicaid
47 fraud control unit, or iIf it is determined by the department that any condi-
48 tion of payment contained in rule, regulation, statute, or provider agreement
49 was not met, the department may initiate administrative proceedings to recover
50 any payments made for items or services. Interest shall accrue on overpayments
51 at the statutory rate set forth in section 28-22-104, Idaho Code, from the
52 date of final determination of the amount owed for items or services until the
53 date of recovery.
54 (56) Provider status. The department may terminate the provider agreement
55 or otherwise deny provider status to any individual or entity who:
5
1 (a) Submits a claim with knowledge that the claim is incorrect, including
2 reporting costs as allowable which were known to be disallowed in a previ-
3 ous audit, unless the provider clearly indicates that the item is being
4 claimed to establish the basis for an appeal and each disputed item and
5 amount is specifically identified; or
6 (b) Submits a fraudulent claim; or
7 (c) Knowingly makes a false statement or representation of material fact
8 in any document required to be maintained or submitted to the department;
9 or
10 (d) Submits a claim for an item or service known to be medically unneces-
11 sary; or
12 (e) Fails to provide, upon written request by the department, immediate
13 access to documentation required to be maintained; or
14 (f) Fails repeatedly or substantially to comply with the rules and regu-
15 lations governing medical assistance payments; or
16 (g) Knowingly violates any material term or condition of its provider
17 agreement; or
18 (h) Has failed to repay, or was a "managing employee" or had an
19 "ownership or control interest" in any entity that has failed to repay,
20 any overpayments or claims previously found to have been obtained contrary
21 to statute, rule, regulation or provider agreement; or
22 (i) Has been found, or was a "managing employee" in any entity which has
23 been found, to have engaged in fraudulent conduct or abusive conduct in
24 connection with the delivery of health care items or services; or
25 (j) Fails to meet the qualifications specifically required by rule or by
26 any applicable licensing board.
27 Any individual or entity denied provider status under this section may be pre-
28 cluded from participating as a provider in the medical assistance program for
29 up to five (5) years from the date the department's action becomes final.
30 (7) The department must refer all cases of suspected fraud to the medic-
31 aid fraud control unit and shall promptly comply with any request from the
32 medicaid fraud control unit for access to and free copies of any records or
33 information kept by the department or its contractors, computerized data
34 stored by the department or its contractors, and any information kept by
35 providers to which the department is authorized access by law.
36 (68) Civil monetary penalties. The department may also assess civil mone-
37 tary penalties against a provider and any officer, director, owner, and/or
38 managing employee of a provider for conduct identified in subsections (56)(a)
39 through (56)(i) of this section. The amount of the penalties shall be up to
40 one thousand dollars ($1,000) for each item or service improperly claimed,
41 except that in the case of multiple penalties the department may reduce the
42 penalties to not less than twenty-five percent (25%) of the amount of each
43 item or service improperly claimed if an amount can be readily determined.
44 Each line item of a claim, or cost on a cost report is considered a separate
45 claim. These penalties are intended to be remedial, recovering at a minimum
46 costs of investigation and administrative review, and placing the costs asso-
47 ciated with noncompliance on the offending provider.
48 (79) Exclusion. Any individual or entity convicted of a criminal offense
49 related to the delivery of an item or service under any state or federal pro-
50 gram shall be excluded from program participation for a period of not less
51 than ten (10) years. Unless otherwise provided in this section or required by
52 federal law, the department may exclude any individual or entity for a period
53 of not less than one (1) year for any conduct for which the secretary of the
54 department of health and human services or designee could exclude an individ-
55 ual or entity.
6
1 (810) Adoption of rules. The department shall promulgate such rules as are
2 necessary to carry out the policies and purposes of this section.
3 SECTION 3. That Chapter 2, Title 56, Idaho Code, be, and the same is
4 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
5 ignated as Section 56-209o, Idaho Code, and to read as follows:
6 56-209o. FAILURE TO RETAIN RECORDS. (1) Whoever receives payment for
7 treatment, services or goods under the provisions of this chapter or under the
8 state plan pursuant to subchapter XIX or XXI, chapter 7, title 42, U.S.C.,
9 shall retain for a period of at least five (5) years all medical and business
10 records relating to:
11 (a) The treatment or care of any recipient;
12 (b) Services or goods provided to any recipient;
13 (c) Rates paid by the department under the program on behalf of any
14 recipient; and
15 (d) Any records required to be maintained by rule of the department for
16 administration of the medicaid program.
17 (2) It shall be unlawful to intentionally fail to retain the records
18 specified in subsection (1) of this section for a period of at least five (5)
19 years from the date payment was claimed or received, whichever is later, or to
20 knowingly destroy or cause the records specified in subsection (1) of this
21 section to be destroyed within five (5) years from the date payment was
22 claimed or received, whichever is later. Any person who fails to retain
23 records or destroys records or causes records to be destroyed as provided in
24 this subsection (2) shall be subject to the following criminal sanctions:
25 (a) If the treatment, services or goods for which records were not
26 retained or for which records were destroyed amount to not more than one
27 thousand dollars ($1,000), the person shall be guilty of a misdemeanor and
28 shall be sentenced pursuant to section 18-113, Idaho Code.
29 (b) If the value of the treatment, services or goods for which records
30 were not retained or for which records were destroyed is more than one
31 thousand dollars ($1,000), the person shall be guilty of a felony and
32 shall be sentenced pursuant to section 18-112, Idaho Code.
33 (c) If the records not retained or destroyed were used in whole or in
34 part to determine a rate of payment under the program, the person shall be
35 guilty of a misdemeanor and shall be sentenced pursuant to section 18-113,
36 Idaho Code.
37 SECTION 4. That Chapter 2, Title 56, Idaho Code, be, and the same is
38 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
39 ignated as Section 56-226, Idaho Code, and to read as follows:
40 56-226. MEDICAID FRAUD CONTROL UNIT. (1) There is hereby established in
41 the office of the attorney general the medicaid fraud control unit which shall
42 have the authority and responsibilities as set forth in this section.
43 (2) Notwithstanding the authority and responsibility granted to the
44 director of the department to provide for fraud control in other aspects of
45 public assistance and public health programs, the medicaid fraud control unit
46 shall have the authority and responsibility to conduct a statewide program for
47 the investigation and prosecution of violations of all applicable Idaho laws
48 pertaining to fraud in the administration of the medicaid program, the provi-
49 sion of medical assistance and in the activities of providers of medical
50 assistance and services under the state plan. Further, upon approval of the
51 inspector general of the relevant federal agency, the office of the attorney
7
1 general shall have the authority and responsibility to investigate and to
2 prosecute violations of any aspect of the provision of health care services
3 and activities of providers of such services under any federal health care
4 program as defined in 42 U.S.C. section 1320(a)-7b(f)1, if the suspected fraud
5 or violation of law in such investigation or prosecution is substantially
6 related to the state plan. The medicaid fraud control unit shall be under the
7 exclusive control of the attorney general and be separate and distinct from
8 the department. No official from the department shall have authority to review
9 or override the prosecutorial decisions made by the medicaid fraud control
10 unit.
11 (3) The medicaid fraud control unit shall also:
12 (a) Review complaints of abuse or neglect of medicaid recipients in
13 health care facilities which receive payment pursuant to the state plan
14 and may review complaints of the misappropriation of patients' private
15 funds in such facilities; and
16 (b) Review complaints of abuse or neglect of medicaid recipients residing
17 in a board and care facility.
18 (4) The medicaid fraud control unit shall attempt to collect or refer to
19 the department for collection overpayments that are made to providers of
20 facilities under the state plan or under any federal health care program to
21 health care facilities that are the result of fraudulent acts and that are
22 discovered by the medicaid fraud control unit in carrying out its responsibil-
23 ities under this section. Notwithstanding any other provision of Idaho Code,
24 all funds collected by the medicaid fraud control unit in accordance with this
25 subsection (4) shall be deposited into the state general fund.
26 (5) The office of the attorney general shall employ such auditors, attor-
27 neys, investigators and other personnel as are necessary to carry out the
28 responsibilities of the medicaid fraud control unit as set forth under this
29 section.
30 (6) The office of the attorney general shall submit to the secretary of
31 the federal department of health and human services applications and reports
32 containing such information as is determined by the secretary by regulation to
33 be necessary to meet the requirements of subchapter XIX, chapter 7, title 42,
34 U.S.C.
35 (7) In carrying out its duties and responsibilities under this section,
36 the medicaid fraud control unit may:
37 (a) Request and receive the assistance of any prosecutor or law enforce-
38 ment agency in the investigation and prosecution of any violation of any
39 applicable Idaho laws pertaining to fraud in the administration of the
40 medicaid program, the provision of medical assistance and in the activi-
41 ties of providers of medical assistance and services under the state plan;
42 (b) Enter upon the premises of any provider participating in the medicaid
43 program to:
44 (i) Examine all accounts and records that are relevant in determin-
45 ing the existence of fraud in the medicaid program;
46 (ii) Investigate alleged abuse or neglect of medicaid recipients; or
47 (iii) Investigate alleged misappropriation of patients' private
48 funds. The accounts or records of a nonmedicaid recipient may not be
49 reviewed by, or turned over to the medicaid fraud control unit with-
50 out the patient's written consent or a court order; and
51 (c) Notwithstanding any other provision of law, upon written request have
52 full access to all records held by a medicaid provider, or by any other
53 person on his or her behalf, that are relevant to the determination of
54 the:
55 (i) Existence of civil violations or criminal offenses under this
8
1 chapter or related offenses;
2 (ii) Existence of medicaid recipient abuse, mistreatment or neglect;
3 or
4 (iii) Theft of medicaid recipient funds.
5 No person holding such records shall refuse to provide the medicaid fraud
6 control unit access to such records for the purposes described in this
7 section on the basis that release would violate the medicaid recipient's
8 right of privacy or privilege against disclosure or use or any profes-
9 sional or other privilege or right.
10 (8) The medicaid fraud control unit shall safeguard the privacy rights of
11 medicaid recipients to avoid unnecessary disclosure of personal information
12 concerning named medicaid recipients. The medicaid fraud control unit may
13 transmit such information that it deems appropriate to the department and to
14 other agencies concerned with the regulation of health care facilities or
15 health professionals.
16 (9) The attorney general shall have the authority to adopt rules neces-
17 sary to implement the duties and responsibilities assigned to the medicaid
18 fraud control unit under this section.
19 (10) As used in this section:
20 (a) "Board and care facility" means a provider of medicaid services in a
21 residential setting which receives payment from or on behalf of two (2) or
22 more unrelated adults who reside in such facility, and for whom one (1) or
23 more of the following is provided:
24 (i) Nursing care services provided by, or under the supervision of,
25 a registered nurse, licensed practical nurse or certified nurses
26 aide; or
27 (ii) A substantial amount of personal care services that assist res-
28 idents with the activities of daily living, including personal
29 hygiene, dressing, bathing, eating, toileting, ambulation, transfer
30 of positions, self-medication, body care, travel to medical services,
31 essential shopping, meal preparation, laundry and housework.
32 (b) "Department" means the Idaho department of health and welfare.
33 (c) "Director" means the director of the Idaho department of health and
34 welfare.
35 (d) "Medicaid" means Idaho's medical assistance program.
36 (e) "Provider" means any individual, partnership, association, corpora-
37 tion or organization, public or private, which provides residential or
38 assisted living services, certified family home services, nursing facility
39 services or services offered pursuant to medical assistance.
40 (f) "Recipient" means an individual determined eligible by the director
41 for the services provided in the state plan for medicaid.
42 (g) "State plan" means the Idaho state plan pursuant to subchapter XIX,
43 chapter 7, title 42 U.S.C.
44 SECTION 5. That Section 56-227, Idaho Code, be, and the same is hereby
45 amended to read as follows:
46 56-227. FRAUDULENT ACTS -- PENALTY. (a) Whoever knowingly obtains, or
47 attempts to obtain, or aids or abets any person in obtaining, by means of a
48 willfully false statement or representation, material omission, or fraudulent
49 devices, public assistance, relief or federal-aid assistance to which he is
50 not entitled, or in an amount greater than that to which he is justly enti-
51 tled, shall be punished in the same manner and to the same extent as for lar-
52 ceny or theft of the money or value of the public assistance so obtained or
53 attempted to be so obtained.
9
1 (b) Whoever sells, conveys, mortgages or otherwise disposes of his prop-
2 erty, real or personal, or conceals his income or resources, for the purpose
3 of rendering him eligible for any form of assistance, theretofore or thereaf-
4 ter applied for, to which he would not otherwise be entitled, shall be pun-
5 ished in the same manner and to the same extent as for larceny or theft of the
6 money or value of the assistance so obtained or so attempted to be obtained.
7 (c) Every person who knowingly aids or abets any person in selling, con-
8 veying, mortgaging or otherwise disposing of his property, real or personal,
9 or in concealing his income or resources for the purpose of rendering him
10 eligible for any form of public assistance or relief, theretofore or thereaf-
11 ter applied for and received, to which he would not otherwise be entitled,
12 shall be punished in the same manner and to the same extent as for larceny or
13 theft of the money or value of the public assistance or relief so obtained or
14 attempted to be obtained.
15 (d) For the purpose of this section federal-aid assistance shall include
16 the specific categories of assistance for which provision is made in any fed-
17 eral law existing or hereafter enacted by the congress of the United States by
18 which payments are made from the federal government to the state in aid or in
19 respect to payment by the state for welfare purposes to any category of needy
20 person and any other program of assistance for which provision for federal
21 funds for aid may from time to time be made.
22 (e) The state department of health and welfare shall establish and oper-
23 ate a fraud control program as permitted by section 416 of the social security
24 act as now or hereafter amended.
25 SECTION 6. That Section 56-227B, Idaho Code, be, and the same is hereby
26 amended to read as follows:
27 56-227B. PROVIDER FRAUD -- DAMAGES. Any provider who knowingly with
28 intent to defraud by means of false statement or representation, obtains com-
29 pensation from public funds greater than that to which he is legally entitled
30 for services or supplies furnished or purportedly furnished shall be liable
31 for civil damages equal to three (3) times the amount by which any figure is
32 falsely overstated. The director of the department of health and welfare or
33 the attorney general shall have the right to cause legal action to be taken
34 for the recovery of such damages when persuaded that a reimbursement claim for
35 payment is falsely overstated. The burden of proof for such recovery action
36 shall be that which is used in other civil actions for the recovery of dam-
37 ages. The remedy provided by this section shall be in addition to any other
38 remedy provided by law.
39 If any provider of services or supplies is required to refund or repay all
40 or part of any payment received by said provider under the provisions of this
41 section, said refund or repayment shall bear interest from the date payment
42 was made to such provider to the date of said refund or repayment. Interest
43 shall accrue at the rate of ten per cent percent (10%) per annum. If, as a
44 result of such The prevailing party in an action, the provider of services or
45 supplies is not required to refund or repay any payment received by said pro-
46 vider under the terms of this section, shall be awarded costs and reasonable
47 attorney's fees shall be allowed the provider incurred in bringing or defend-
48 ing the action. Notwithstanding any other provision of the Idaho Code, all
49 costs and attorney's fees awarded to the department of health and welfare or
50 the attorney general pursuant to this section shall be deposited into the
51 state general fund.
52 SECTION 7. That Section 56-227C, Idaho Code, be, and the same is hereby
10
1 amended to read as follows:
2 56-227C. SUBPOENA POWER. (1) The director, or his authorized representa-
3 tive, and the director of the Idaho state police, or his authorized represen-
4 tative, and any prosecuting attorney of any county, for the purposes contem-
5 plated by this act, have power to issue subpoenas, compel the attendance of
6 witnesses, administer oaths, certify to official acts, take depositions within
7 and without the state of Idaho, as now provided by law, compel the production
8 of pertinent books, payrolls, accounts, papers, records, documents and testi-
9 mony. If a person in attendance before such director or his authorized repre-
10 sentative or prosecuting attorney refuses, without reasonable cause, to be
11 examined or to answer a legal and pertinent question, or to produce a book or
12 paper or other evidence when ordered so to do by the director or his autho-
13 rized representative, or prosecuting attorney, said director or his authorized
14 representative or prosecuting attorney may apply to the judge of the district
15 court of the county where such person is in attendance, upon affidavit for an
16 order returnable in not less than two (2) or more than five (5) days, direct-
17 ing such person to show cause before such judge, or any other judge of such
18 district, why he should not be punished for contempt; upon the hearing of such
19 order, if the judge shall determine that such person has refused, without rea-
20 sonable cause or legal excuse, to be examined or to answer a legal or perti-
21 nent question, or to produce a book or paper which he was ordered to bring or
22 produce, he may forthwith punish the offender as for contempt of court.
23 (a) No If any person shall asks to be excused from attending or testify-
24 ing or from producing any books, or payrolls, accounts, papers, records,
25 or documents or other evidence in connection with any investigation or
26 inquiry by or upon any hearing before any officer so authorized upon pur-
27 suant to this subsection (1), or in any proceeding or action before any
28 court upon a charge or violation of this subsection (1), on the ground
29 that the testimony or evidence, books, papers or documents required of him
30 may tend to incriminate him or subject him to penalty or forfeiture; but
31 no person shall be prosecuted, punished or subjected to any penalty or
32 forfeiture for or on account of any act, transaction, matter or thing con-
33 cerning which he is compelled, after claiming his privileges against self-
34 incrimination, to testify or produce evidence, documentary or otherwise,
35 except that any person so testifying shall not be exempt from prosecution
36 and punishment for perjury committed in so testifying, and if such person,
37 notwithstanding such request, is directed to give such testimony or pro-
38 duce such evidence, the person must, if so directed by the director or his
39 authorized representative, comply with such direction.
40 (b) After complying, and if, but for this subsection (1), the person
41 would have been privileged to withhold the answer given or the evidence
42 produced by him, then the answer, the evidence and any information
43 directly or indirectly derived from the answer or evidence, may not be
44 used against the compelled person in any manner in a criminal case, except
45 that the person may nevertheless be prosecuted or subjected to penalty or
46 forfeiture for any perjury, false swearing or contempt committed in
47 answering or failing to answer or in producing or failing to produce evi-
48 dence in accordance with the order. Such evidence may be used in the
49 refusal, suspension or revocation of any license, permission or authority
50 conferred, or to be conferred, pursuant to Idaho Code.
51 (2) The attorney general or any prosecuting attorney or the designated
52 agent of either shall have the authority to issue subpoenas to an enrolled or
53 formerly enrolled provider of services pursuant to the medicaid program to
54 compel production of books, payrolls, accounts, papers, records, documents and
11
1 other items that may be relevant to an investigation of fraud or other crime
2 directly related to the use of medicaid program funds or services provided
3 through the medicaid program that are not already in the possession of the
4 director of the department of health and welfare or his designated agent. The
5 attorney general or any prosecuting attorney or the designated agent of either
6 may also compel testimony by the custodian of the items subpoenaed concerning
7 the production and authenticity of those items.
8 (a) A subpoena under this subsection (2) shall describe the items
9 required to be produced with particularity and prescribe a return date of
10 a reasonable period of time within which the items can be assembled and
11 made available to the attorney general or any prosecuting attorney or the
12 designated agent of either.
13 (b) At any time before the return date specified in the subpoena, the
14 enrolled or formerly enrolled provider who offers services pursuant to the
15 medicaid program may apply to a judge of the district court of the county
16 where such provider is in attendance, for an order modifying or quashing
17 the subpoena. A subpoena that requests items that are reasonably relevant
18 to an investigation of fraud or other crime directly related to the use of
19 medicaid program funds or services provided through the medicaid program,
20 shall not be modified or quashed. Probable cause for the issuance of an
21 investigatory subpoena under this subsection (2) shall not be required.
22 (3) Subpoenas issued pursuant to this section shall be served and witness
23 fees and mileage paid as allowed in civil cases in the district courts of this
24 state.
25 (4) Inspectors and iInvestigators employed by the Idaho state police
26 attorney general for the enforcement of this act investigation and prosecution
27 of providers of services pursuant to the medicaid program shall have all the
28 authority given by statute to peace officers of the state of Idaho, including,
29 but not limited to, authority to obtain, serve and execute warrants of arrest
30 and warrants of search and seizure.
31 SECTION 8. That Section 56-227D, Idaho Code, be, and the same is hereby
32 amended to read as follows:
33 56-227D. FEDERAL FOOD STAMPS -- UNAUTHORIZED USE -- EXCEPTION -- DEFINI-
34 TION. (a1) It is a misdemeanor for any person to buy, receive, sell, give
35 away, dispose of, exchange or barter any federal food stamps of a value of one
36 hundred fifty dollars ($150) or less, except for the eligible foods for which
37 they are issued.
38 (b2) It is a felony for any person to buy, receive, sell, give away, dis-
39 pose of, exchange or barter any federal food stamps of a value exceeding one
40 hundred fifty dollars ($150), except for the eligible foods for which they are
41 issued.
42 (c3) This section does not apply to any person buying, receiving, sell-
43 ing, giving away, disposing of, exchanging or bartering any federal food
44 stamps subsequent to the redemption of such stamps in the manner provided by
45 state or federal law.
46 (d4) As used in this section, federal food stamps refers to stamps issued
47 for food by the United States department of agriculture or its duly authorized
48 agent.
49 (5) This section shall be enforced by the director of the department of
50 health and welfare in cooperation with local law enforcement and prosecuting
51 agencies. Such enforcement shall not be the responsibility of the medicaid
52 fraud control unit as provided in section 56-226, Idaho Code.
12
1 SECTION 9. That Chapter 2, Title 56, Idaho Code, be, and the same is
2 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
3 ignated as Section 56-227E, Idaho Code, and to read as follows:
4 56-227E. OBSTRUCTION OF INVESTIGATION. (1) An obstruction of investiga-
5 tion consists of knowingly:
6 (a) Providing false information to, or knowingly withholding information
7 from, any person authorized to investigate a violation of this chapter or
8 to enforce the criminal or civil remedies of this chapter where that
9 information is material to the investigation or enforcement; or
10 (b) Altering any document or record required to be retained pursuant to
11 this chapter or any rule issued by the department of health and welfare,
12 when the alteration is intended to mislead an investigation and concerns
13 information material to that investigation.
14 (2) Whoever commits an obstruction of investigation shall be guilty of a
15 felony and shall be sentenced pursuant to the provisions of section 18-112,
16 Idaho Code.
17 SECTION 10. That Section 67-1401, Idaho Code, be, and the same is hereby
18 amended to read as follows:
19 67-1401. DUTIES OF ATTORNEY GENERAL. Except as otherwise provided in this
20 chapter, it is the duty of the attorney general:
21 (1.) To perform all legal services for the state and to represent the
22 state and all departments, agencies, offices, officers, boards, commissions,
23 institutions and other state entities, in all courts and before all adminis-
24 trative tribunals or bodies of any nature. Representation shall be provided to
25 those entities exempted pursuant to the provisions of section 67-1406, Idaho
26 Code. Whenever required to attend upon any court or administrative tribunal
27 the attorney general shall be allowed necessary and actual expenses, all
28 claims for which shall be audited by the state board of examiners.
29 (2.) To advise all departments, agencies, offices, officers, boards, com-
30 missions, institutions and other state entities in all matters involving ques-
31 tions of law.
32 (3.) After judgment in any of the causes referred to in the first subdi-
33 vision, to direct the issuing of such process as may be necessary to carry the
34 same into execution.
35 (4.) To account for and pay over to the proper officer all moneys
36 received which belong to the state.
37 (5.) To supervise nonprofit corporations, corporations, charitable or
38 benevolent societies, person or persons holding property subject to any public
39 or charitable trust and to enforce whenever necessary any noncompliance or
40 departure from the general purpose of such trust and, in order to accomplish
41 such purpose, said nonprofit corporations, corporations, charitable or benevo-
42 lent societies, person or persons holding property subject to any public or
43 charitable trust are subject at all times to examination by the attorney gen-
44 eral, on behalf of the state, to ascertain the condition of its affairs and to
45 what extent, if at all, said trustee or trustees may have failed to comply
46 with trusts said trustee or trustees have assumed or may have departed from
47 the general purpose for which it was formed. In case of any such failure or
48 departure, the attorney general shall institute, in the name of the state, any
49 proceeding necessary to enforce compliance with the terms of the trust or any
50 departure therefrom.
51 (6.) To give an opinion in writing, without fee, to the legislature or
52 either house thereof, or any senator or representative, and to the governor,
13
1 secretary of state, treasurer, state controller, and the superintendent of
2 public instruction, when requested, upon any question of law relating to their
3 respective offices. The attorney general shall keep a record of all written
4 opinions rendered by the office and such opinions shall be compiled annually
5 and made available for public inspection. All costs incurred in the prepara-
6 tion of said opinions shall be borne by the office of the attorney general. A
7 copy of the opinions shall be furnished to the supreme court and to the state
8 librarian.
9 (7.) When required by the public service, to repair to any county in the
10 state and assist the prosecuting attorney thereof in the discharge of duties.
11 (8.) To bid upon and purchase, when necessary, in the name of the state,
12 and under the direction of the state controller, any property offered for sale
13 under execution issued upon judgments in favor of or for the use of the state,
14 and to enter satisfaction in whole or in part of such judgments as the consid-
15 eration for such purchases.
16 (9.) Whenever the property of a judgment debtor in any judgment mentioned
17 in the preceding subdivision has been sold under a prior judgment, or is sub-
18 ject to any judgment, lien, or encumbrance, taking precedence of the judgment
19 in favor of the state, under the direction of the state controller, to redeem
20 such property from such prior judgment, lien, or encumbrance; and all sums of
21 money necessary for such redemption must, upon the order of the board of exam-
22 iners, be paid out of any money appropriated for such purposes.
23 (10.) When necessary for the collection or enforcement of any judgment
24 hereinbefore mentioned, to institute and prosecute, in behalf of the state,
25 such suits or other proceedings as may be necessary to set aside and annul all
26 conveyances fraudulently made by such judgment debtors; the cost necessary to
27 the prosecution must, when allowed by the board of examiners, be paid out of
28 any appropriations for the prosecution of delinquents.
29 (11.) To exercise all the common law power and authority usually apper-
30 taining to the office and to discharge the other duties prescribed by law.
31 (12.) To report to the governor, at the time required by this code, the
32 condition of the affairs of the attorney general's office and of the reports
33 received from prosecuting attorneys.
34 (13.) To appoint deputy attorneys general and special deputy attorneys
35 general and other necessary staff to assist in the performance of the duties
36 of the office. Such deputies and staff shall be nonclassified employees within
37 the meaning of section 67-5302, Idaho Code.
38 (14) To establish a medicaid fraud control unit pursuant to the provi-
39 sions of section 56-226, Idaho Code, and to exercise concurrent investigative
40 and prosecutorial authority and responsibility with county prosecutors to
41 prosecute persons for the violation of the criminal provisions of chapter 2,
42 title 56, Idaho Code, and for criminal offenses that are not defined in said
43 chapter 2, title 56, Idaho Code, but that involve or are directly related to
44 the use of medicaid program funds or services provided through the medicaid
45 program.
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
Moved by Lodge
Seconded by Burkett
IN THE SENATE
SENATE AMENDMENTS TO H.B. NO. 166, As Amended
1 AMENDMENT TO SECTION 2
2 On page 4 of the engrossed bill, delete lines 36 through 38, and insert:
3 "pected case of fraud or abuse and the department has reason to believe that
4 payments made during the investigation may be difficult or impractical to
5 recover, the department may suspend or withhold payments to the provider
6 pend-".
7 AMENDMENT TO SECTION 3
8 On page 6, delete lines 9 through 15, and insert: "shall retain for a
9 period of at least five (5) years all records required to be maintained by
10 rule of the department for".
11 AMENDMENTS TO SECTION 7
12 On page 11, delete lines 3 and 4, and insert: "compel production of any
13 books, payrolls, accounts, papers, records or documents that are required to
14 be maintained under the medicaid provider agreement executed by such provider
15 or formerly enrolled provider as may be relevant to an investigation of fraud
16 or other crime"; and delete lines 10 through 24, and insert: "the production
17 and authenticity of those items. Subpoenas for records or information which
18 are not required to be maintained under a provider agreement shall only be
19 issued through subpoena powers in judicial proceedings. A subpoena under this
20 subsection (2) shall describe the items required to be produced with particu-
21 larity and prescribe a return date of a reasonable period of time within which
22 the items can be assembled and made available to the attorney general or any
23 prosecuting attorney or the designated agent of either.".
24 AMENDMENTS TO SECTION 9
25 On page 12, in line 9, following "person" insert: "requesting such infor-
26 mation if that person is"; and in line 11, following "is" insert: "properly
27 requested and is".
28 CORRECTION TO TITLE
29 On page 1, in line 6, delete "REMOVE A CONDITION FOR ACTION, TO".
2
Moved by Henbest
Seconded by Bilbao
IN THE HOUSE OF REPRESENTATIVES
HOUSE AMENDMENT TO H.B. NO. 166
1 AMENDMENTS TO SECTION 3
2 On page 6 of the printed bill, in line 17, delete "to intentionally" and
3 insert: "with an intent to evade or avoid the provisions of this act: to"; in
4 line 19, following "later" delete "," and insert: ";"; in line 22, following
5 "who" insert: ", with an intent to evade or avoid the provisions of this
6 act,"; and in line 24, following "(2)" insert: ", with an intent to evade or
7 avoid the provisions of this act,".
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 166, As Amended, As Amended in the Senate
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAID; AMENDING SECTION 15-8-103, IDAHO CODE, TO MAKE A TECHNI-
3 CAL CORRECTION; AMENDING SECTION 56-209h, IDAHO CODE, TO DEFINE A TERM, TO
4 PROVIDE FOR A MEDICAID FRAUD PROGRAM IN THE DEPARTMENT OF HEALTH AND WEL-
5 FARE AND THE SCOPE OF SUCH PROGRAM, TO REMOVE A TIME REQUIREMENT, TO PRO-
6 VIDE FOR ACTION UPON REFERRAL, TO PROVIDE REFERRAL AND COMPLIANCE REQUIRE-
7 MENTS, TO PROVIDE FOR A MINIMUM FOR COST RECOVERY AND TO MAKE A TECHNICAL
8 CORRECTION; AMENDING CHAPTER 2, TITLE 56, IDAHO CODE, BY THE ADDITION OF
9 NEW SECTIONS 56-209o AND 56-226, IDAHO CODE, TO PROVIDE FOR RECORD RETEN-
10 TION REQUIREMENTS, TO PROVIDE FOR CRIMINAL PENALTIES, TO ESTABLISH IN THE
11 OFFICE OF THE ATTORNEY GENERAL THE MEDICAID FRAUD CONTROL UNIT, TO PROVIDE
12 THE DUTIES, AUTHORITY AND RESPONSIBILITIES OF THE UNIT, TO PROVIDE EXCLU-
13 SIVE CONTROL OF THE UNIT AND TO DEFINE TERMS; AMENDING SECTION 56-227,
14 IDAHO CODE, TO REMOVE A REQUIREMENT FOR THE DEPARTMENT OF HEALTH AND WEL-
15 FARE TO ESTABLISH AND OPERATE A FRAUD CONTROL PROGRAM; AMENDING SECTION
16 56-227B, IDAHO CODE, TO PROVIDE FOR THE RIGHT OF THE ATTORNEY GENERAL TO
17 CAUSE CERTAIN LEGAL ACTION TO BE UNDERTAKEN, TO PROVIDE FOR COSTS AND REA-
18 SONABLE ATTORNEY'S FEES TO BE AWARDED TO THE PREVAILING PARTY, TO PROVIDE
19 FOR THE DISPOSITION OF COSTS AND ATTORNEY'S FEES AND TO MAKE A TECHNICAL
20 CORRECTION; AMENDING SECTION 56-227C, IDAHO CODE, TO REQUIRE PERSONS ASK-
21 ING TO BE EXCUSED FROM ATTENDING, PRODUCING OR TESTIFYING ON THE GROUNDS
22 OF SELF-INCRIMINATION TO COMPLY WITH THE REQUEST, TO PROVIDE FOR THE USE
23 OF INFORMATION PROVIDED BY PERSONS PRIVILEGED TO WITHHOLD INFORMATION, TO
24 PROVIDE AUTHORITY TO THE ATTORNEY GENERAL AND ANY PROSECUTING ATTORNEY TO
25 ISSUE SUBPOENAS AND COMPEL TESTIMONY FROM CUSTODIANS, TO PROVIDE SUBPOENA
26 REQUIREMENTS, TO PROVIDE PROCEDURE AND GROUNDS FOR MODIFYING OR QUASHING A
27 SUBPOENA AND TO PROVIDE PEACE OFFICER STATUS TO INVESTIGATORS EMPLOYED BY
28 THE ATTORNEY GENERAL; AMENDING SECTION 56-227D, IDAHO CODE, TO PROVIDE
29 ENFORCEMENT AUTHORITY TO THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WEL-
30 FARE, TO PROVIDE THAT SUCH ENFORCEMENT IS NOT THE RESPONSIBILITY OF THE
31 MEDICAID FRAUD UNIT AND TO MAKE TECHNICAL CORRECTIONS; AMENDING CHAPTER 2,
32 TITLE 56, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 56-227E, IDAHO
33 CODE, TO PROVIDE A DESCRIPTION OF OBSTRUCTION OF INVESTIGATION AND TO PRO-
34 VIDE CRIMINAL PENALTIES; AND AMENDING SECTION 67-1401, IDAHO CODE, TO
35 REVISE DUTIES OF THE ATTORNEY GENERAL AND TO MAKE TECHNICAL CORRECTIONS.
36 Be It Enacted by the Legislature of the State of Idaho:
37 SECTION 1. That Section 15-8-103, Idaho Code, be, and the same is hereby
38 amended to read as follows:
39 15-8-103. DEFINITIONS. The definitions in this section apply throughout
40 this chapter unless the context clearly requires otherwise:
41 (1) "Matter" includes any issue, question or dispute involving:
42 (a) The determination of any class of creditors, devisees, legatees,
43 heirs, next of kin, or other persons interested in an estate, trust,
2
1 nonprobate asset, or with respect to any other asset or property interest
2 passing at death;
3 (b) The direction of a personal representative or trustee to do or to
4 abstain from doing any act in a fiduciary capacity;
5 (c) The determination of any question arising in the administration of an
6 estate or trust, or with respect to any nonprobate asset, or with respect
7 to any other asset or property interest passing at death, that may
8 include, without limitation, questions relating to:
9 (i) The construction of wills, trusts, devolution agreements, and
10 other writings;
11 (ii) A change of personal representative or trustee;
12 (iii) A change of the situs of a trust;
13 (iv) An accounting from a personal representative or trustee; or
14 (v) The determination of fees for a personal representative or
15 trustee;
16 (d) The grant to a personal representative or trustee of any necessary or
17 desirable power not otherwise granted in the governing instrument or given
18 by law;
19 (e) The amendment, reformation, or conformation of a will or a trust
20 instrument to comply with statutes and regulations of the United States
21 internal revenue service in order to more efficiently allocate exemptions
22 or to achieve qualification for deductions, elections, and other tax
23 requirements including, but not limited to, the qualification of any gift
24 thereunder for the benefit of a surviving spouse who is not a citizen of
25 the United States for the estate tax marital deduction permitted by fed-
26 eral law, including the addition of mandatory governing instrument
27 requirements for a qualified domestic trust under section 2056A of the
28 Internal Revenue Code, the qualification of any gift thereunder as a qual-
29 ified conservation easement as permitted by federal law, or the qualifica-
30 tion of any gift for the charitable estate tax deduction permitted by fed-
31 eral law, including the addition of mandatory governing instrument
32 requirements for a charitable remainder trust; and
33 (f) With respect to any nonprobate asset, or with respect to any other
34 asset or property interest passing at death, including actual joint ten-
35 ancy property, property subject to a devolution agreement, or assets sub-
36 ject to a pay on death or transfer on death designation:
37 (i) The ascertaining of any class of creditors or others for pur-
38 poses of section 15-6-107, Idaho Code;
39 (ii) The ordering of a custodian of any of the decedent's records
40 relating to a nonprobate asset to do or abstain from doing any par-
41 ticular act with respect to those records;
42 (iii) The determination of any question arising in the administration
43 of a nonprobate asset under section 15-6-107, Idaho Code;
44 (iv) The determination of any questions relating to the abatement,
45 rights of creditors, or other matter relating to the administration,
46 settlement, or final disposition of a nonprobate asset under title
47 15, Idaho Code; and
48 (v) The resolution of any matter referencing this chapter, includ-
49 ing a determination of any questions relating to the ownership or
50 distribution of an individual retirement account on the death of the
51 spouse of the account holder as contemplated by section 11-604A(6),
52 Idaho Code;
53 (g) The resolution of any other matter that could affect the nonprobate
54 asset.
55 (2) "Nonprobate assets" means assets that are covered by chapter 6, title
3
1 15, Idaho Code.
2 (3) "Party" or "parties" means each of the following persons who has an
3 interest in the subject of the particular proceeding and whose name and
4 address are known to, or are reasonably ascertainable by, the petitioner:
5 (a) The trustor if living;
6 (b) The trustee;
7 (c) The personal representative;
8 (d) An heir;
9 (e) A beneficiary, including devisees, legatees, and trust beneficiaries;
10 (f) The surviving spouse of a decedent with respect to his or her inter-
11 est in the decedent's property;
12 (g) A guardian ad litem;
13 (h) A creditor;
14 (i) Any other person who has an interest in the subject of the particular
15 proceeding;
16 (j) The attorney general if required under section 67-1401(5.), Idaho
17 Code;
18 (k) Any duly appointed and acting legal representative of a party such as
19 a guardian, conservator, special representative, or attorney in fact;
20 (l) Where applicable, the virtual representative of any person described
21 in this subsection (3), the giving of notice to whom would meet notice
22 requirements as provided in section 15-8-204, Idaho Code; and
23 (m) The owner or the personal representative of the estate of the
24 deceased owner of the nonprobate asset that is the subject of the particu-
25 lar proceeding, if the subject of the particular proceeding relates to the
26 beneficiary's liability to a decedent's estate or creditors under section
27 15-6-107, Idaho Code.
28 (4) "Persons interested in the estate or trust" means the trustor, if
29 living, all persons beneficially interested in the estate or trust, persons
30 holding powers over the trust or estate assets, the attorney general in the
31 case of any charitable trust where the attorney general would be a necessary
32 party to judicial proceedings concerning the trust, and any personal represen-
33 tative or trustee of the estate or trust.
34 (5) "Representative" and other similar terms refer to a person who virtu-
35 ally represents another person under section 15-8-205, Idaho Code.
36 (6) "Trustee" means any acting and qualified trustee of the trust.
37 SECTION 2. That Section 56-209h, Idaho Code, be, and the same is hereby
38 amended to read as follows:
39 56-209h. ADMINISTRATIVE REMEDIES. (1) Definitions. For purposes of this
40 section:
41 (a) "Abuse" or "abusive" means provider practices that are inconsistent
42 with sound fiscal, business, or medical practices, and result in an unnec-
43 essary cost to the medical assistance program, in reimbursement for ser-
44 vices that are not medically necessary or that fail to meet professionally
45 recognized standards for health care, or in physical harm, pain or mental
46 anguish to a medical assistance recipient.
47 (b) "Claim" means any request or demand for payment of items or services
48 under the state's medical assistance program, whether under a contract or
49 otherwise.
50 (c) "Fraud" or "Ffraudulent" means an intentional deception or misrepre-
51 sentation made by a person with the knowledge that the deception could
52 result in some unauthorized benefit to himself or some other person.
53 (d) "Knowingly," "known" or "with knowledge" means that a person, with
4
1 respect to information or an action:
2 (i) Has actual knowledge of the information or action; or
3 (ii) Acts in deliberate ignorance of the truth or falsity of the
4 information or the correctness or incorrectness of the action; or
5 (iii) Acts in reckless disregard of the truth or falsity of the
6 information or the correctness or incorrectness of the action.
7 (e) "Managing employee" means a general manager, business manager, admin-
8 istrator, director or other individual who exercises operational or mana-
9 gerial control over, or who directly or indirectly conducts the day-to-day
10 operation of, an institution, organization or agency.
11 (f) "Medicaid fraud control unit" means that medicaid fraud control unit
12 as provided for in section 56-226, Idaho Code.
13 (g) "Ownership or control interest" means a person or entity that:
14 (i) Has an ownership interest totaling twenty-five percent (25%) or
15 more in an entity; or
16 (ii) Is an officer or director of an entity that is organized as a
17 corporation; or
18 (iii) Is a partner in an entity that is organized as a partnership;
19 or
20 (iv) Is a managing member in an entity that is organized as a lim-
21 ited liability company.
22 (2) The department shall establish and operate an administrative fraud
23 control program to enforce violations of the provisions of this chapter and of
24 the state plan pursuant to subchapters XIX and XXI, chapter 7, title 42,
25 U.S.C., that are outside the scope of the duties of the medicaid fraud control
26 unit and to render and receive referrals from and to said unit.
27 (3) Review of dDocumentation of services. All claims submitted by
28 providers for payment are subject to prepayment and postpayment review as des-
29 ignated by rule. Except as otherwise provided by rule, providers shall gener-
30 ate documentation at the time of service sufficient to support each claim. and
31 shall retain the documentation for a minimum of five (5) years from the date
32 the item or service was provided. The department or authorized agent shall be
33 given immediate access to such documentation upon written request.
34 (34) Immediate action. In the event that the department identifies a sus-
35 pected case of fraud or abuse and the department has reason to believe that
36 payments made during the investigation may be difficult or impractical to
37 recover, the department may suspend or withhold payments to the provider pend-
38 ing investigation. In the event that the department identifies a suspected
39 case of fraud or abuse and it determines that it is necessary to prevent or
40 avoid immediate danger to the public health or safety, the department may sum-
41 marily suspend a provider agreement pending investigation. When payments have
42 been suspended or withheld or a provider agreement suspended pending investi-
43 gation, the department shall provide for a hearing within thirty (30) days of
44 receipt of any duly filed notice of appeal.
45 (45) Recovery of payments. Upon referral of a matter from the medicaid
46 fraud control unit, or iIf it is determined by the department that any condi-
47 tion of payment contained in rule, regulation, statute, or provider agreement
48 was not met, the department may initiate administrative proceedings to recover
49 any payments made for items or services. Interest shall accrue on overpayments
50 at the statutory rate set forth in section 28-22-104, Idaho Code, from the
51 date of final determination of the amount owed for items or services until the
52 date of recovery.
53 (56) Provider status. The department may terminate the provider agreement
54 or otherwise deny provider status to any individual or entity who:
55 (a) Submits a claim with knowledge that the claim is incorrect, including
5
1 reporting costs as allowable which were known to be disallowed in a previ-
2 ous audit, unless the provider clearly indicates that the item is being
3 claimed to establish the basis for an appeal and each disputed item and
4 amount is specifically identified; or
5 (b) Submits a fraudulent claim; or
6 (c) Knowingly makes a false statement or representation of material fact
7 in any document required to be maintained or submitted to the department;
8 or
9 (d) Submits a claim for an item or service known to be medically unneces-
10 sary; or
11 (e) Fails to provide, upon written request by the department, immediate
12 access to documentation required to be maintained; or
13 (f) Fails repeatedly or substantially to comply with the rules and regu-
14 lations governing medical assistance payments; or
15 (g) Knowingly violates any material term or condition of its provider
16 agreement; or
17 (h) Has failed to repay, or was a "managing employee" or had an
18 "ownership or control interest" in any entity that has failed to repay,
19 any overpayments or claims previously found to have been obtained contrary
20 to statute, rule, regulation or provider agreement; or
21 (i) Has been found, or was a "managing employee" in any entity which has
22 been found, to have engaged in fraudulent conduct or abusive conduct in
23 connection with the delivery of health care items or services; or
24 (j) Fails to meet the qualifications specifically required by rule or by
25 any applicable licensing board.
26 Any individual or entity denied provider status under this section may be pre-
27 cluded from participating as a provider in the medical assistance program for
28 up to five (5) years from the date the department's action becomes final.
29 (7) The department must refer all cases of suspected fraud to the medic-
30 aid fraud control unit and shall promptly comply with any request from the
31 medicaid fraud control unit for access to and free copies of any records or
32 information kept by the department or its contractors, computerized data
33 stored by the department or its contractors, and any information kept by
34 providers to which the department is authorized access by law.
35 (68) Civil monetary penalties. The department may also assess civil mone-
36 tary penalties against a provider and any officer, director, owner, and/or
37 managing employee of a provider for conduct identified in subsections (56)(a)
38 through (56)(i) of this section. The amount of the penalties shall be up to
39 one thousand dollars ($1,000) for each item or service improperly claimed,
40 except that in the case of multiple penalties the department may reduce the
41 penalties to not less than twenty-five percent (25%) of the amount of each
42 item or service improperly claimed if an amount can be readily determined.
43 Each line item of a claim, or cost on a cost report is considered a separate
44 claim. These penalties are intended to be remedial, recovering at a minimum
45 costs of investigation and administrative review, and placing the costs asso-
46 ciated with noncompliance on the offending provider.
47 (79) Exclusion. Any individual or entity convicted of a criminal offense
48 related to the delivery of an item or service under any state or federal pro-
49 gram shall be excluded from program participation for a period of not less
50 than ten (10) years. Unless otherwise provided in this section or required by
51 federal law, the department may exclude any individual or entity for a period
52 of not less than one (1) year for any conduct for which the secretary of the
53 department of health and human services or designee could exclude an individ-
54 ual or entity.
55 (810) Adoption of rules. The department shall promulgate such rules as are
6
1 necessary to carry out the policies and purposes of this section.
2 SECTION 3. That Chapter 2, Title 56, Idaho Code, be, and the same is
3 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
4 ignated as Section 56-209o, Idaho Code, and to read as follows:
5 56-209o. FAILURE TO RETAIN RECORDS. (1) Whoever receives payment for
6 treatment, services or goods under the provisions of this chapter or under the
7 state plan pursuant to subchapter XIX or XXI, chapter 7, title 42, U.S.C.,
8 shall retain for a period of at least five (5) years all records required to
9 be maintained by rule of the department for administration of the medicaid
10 program.
11 (2) It shall be unlawful with an intent to evade or avoid the provisions
12 of this act: to fail to retain the records specified in subsection (1) of this
13 section for a period of at least five (5) years from the date payment was
14 claimed or received, whichever is later; or to knowingly destroy or cause the
15 records specified in subsection (1) of this section to be destroyed within
16 five (5) years from the date payment was claimed or received, whichever is
17 later. Any person who, with an intent to evade or avoid the provisions of this
18 act, fails to retain records or destroys records or causes records to be
19 destroyed as provided in this subsection (2), with an intent to evade or avoid
20 the provisions of this act, shall be subject to the following criminal sanc-
21 tions:
22 (a) If the treatment, services or goods for which records were not
23 retained or for which records were destroyed amount to not more than one
24 thousand dollars ($1,000), the person shall be guilty of a misdemeanor and
25 shall be sentenced pursuant to section 18-113, Idaho Code.
26 (b) If the value of the treatment, services or goods for which records
27 were not retained or for which records were destroyed is more than one
28 thousand dollars ($1,000), the person shall be guilty of a felony and
29 shall be sentenced pursuant to section 18-112, Idaho Code.
30 (c) If the records not retained or destroyed were used in whole or in
31 part to determine a rate of payment under the program, the person shall be
32 guilty of a misdemeanor and shall be sentenced pursuant to section 18-113,
33 Idaho Code.
34 SECTION 4. That Chapter 2, Title 56, Idaho Code, be, and the same is
35 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
36 ignated as Section 56-226, Idaho Code, and to read as follows:
37 56-226. MEDICAID FRAUD CONTROL UNIT. (1) There is hereby established in
38 the office of the attorney general the medicaid fraud control unit which shall
39 have the authority and responsibilities as set forth in this section.
40 (2) Notwithstanding the authority and responsibility granted to the
41 director of the department to provide for fraud control in other aspects of
42 public assistance and public health programs, the medicaid fraud control unit
43 shall have the authority and responsibility to conduct a statewide program for
44 the investigation and prosecution of violations of all applicable Idaho laws
45 pertaining to fraud in the administration of the medicaid program, the provi-
46 sion of medical assistance and in the activities of providers of medical
47 assistance and services under the state plan. Further, upon approval of the
48 inspector general of the relevant federal agency, the office of the attorney
49 general shall have the authority and responsibility to investigate and to
50 prosecute violations of any aspect of the provision of health care services
51 and activities of providers of such services under any federal health care
7
1 program as defined in 42 U.S.C. section 1320(a)-7b(f)1, if the suspected fraud
2 or violation of law in such investigation or prosecution is substantially
3 related to the state plan. The medicaid fraud control unit shall be under the
4 exclusive control of the attorney general and be separate and distinct from
5 the department. No official from the department shall have authority to review
6 or override the prosecutorial decisions made by the medicaid fraud control
7 unit.
8 (3) The medicaid fraud control unit shall also:
9 (a) Review complaints of abuse or neglect of medicaid recipients in
10 health care facilities which receive payment pursuant to the state plan
11 and may review complaints of the misappropriation of patients' private
12 funds in such facilities; and
13 (b) Review complaints of abuse or neglect of medicaid recipients residing
14 in a board and care facility.
15 (4) The medicaid fraud control unit shall attempt to collect or refer to
16 the department for collection overpayments that are made to providers of
17 facilities under the state plan or under any federal health care program to
18 health care facilities that are the result of fraudulent acts and that are
19 discovered by the medicaid fraud control unit in carrying out its responsibil-
20 ities under this section. Notwithstanding any other provision of Idaho Code,
21 all funds collected by the medicaid fraud control unit in accordance with this
22 subsection (4) shall be deposited into the state general fund.
23 (5) The office of the attorney general shall employ such auditors, attor-
24 neys, investigators and other personnel as are necessary to carry out the
25 responsibilities of the medicaid fraud control unit as set forth under this
26 section.
27 (6) The office of the attorney general shall submit to the secretary of
28 the federal department of health and human services applications and reports
29 containing such information as is determined by the secretary by regulation to
30 be necessary to meet the requirements of subchapter XIX, chapter 7, title 42,
31 U.S.C.
32 (7) In carrying out its duties and responsibilities under this section,
33 the medicaid fraud control unit may:
34 (a) Request and receive the assistance of any prosecutor or law enforce-
35 ment agency in the investigation and prosecution of any violation of any
36 applicable Idaho laws pertaining to fraud in the administration of the
37 medicaid program, the provision of medical assistance and in the activi-
38 ties of providers of medical assistance and services under the state plan;
39 (b) Enter upon the premises of any provider participating in the medicaid
40 program to:
41 (i) Examine all accounts and records that are relevant in determin-
42 ing the existence of fraud in the medicaid program;
43 (ii) Investigate alleged abuse or neglect of medicaid recipients; or
44 (iii) Investigate alleged misappropriation of patients' private
45 funds. The accounts or records of a nonmedicaid recipient may not be
46 reviewed by, or turned over to the medicaid fraud control unit with-
47 out the patient's written consent or a court order; and
48 (c) Notwithstanding any other provision of law, upon written request have
49 full access to all records held by a medicaid provider, or by any other
50 person on his or her behalf, that are relevant to the determination of
51 the:
52 (i) Existence of civil violations or criminal offenses under this
53 chapter or related offenses;
54 (ii) Existence of medicaid recipient abuse, mistreatment or neglect;
55 or
8
1 (iii) Theft of medicaid recipient funds.
2 No person holding such records shall refuse to provide the medicaid fraud
3 control unit access to such records for the purposes described in this
4 section on the basis that release would violate the medicaid recipient's
5 right of privacy or privilege against disclosure or use or any profes-
6 sional or other privilege or right.
7 (8) The medicaid fraud control unit shall safeguard the privacy rights of
8 medicaid recipients to avoid unnecessary disclosure of personal information
9 concerning named medicaid recipients. The medicaid fraud control unit may
10 transmit such information that it deems appropriate to the department and to
11 other agencies concerned with the regulation of health care facilities or
12 health professionals.
13 (9) The attorney general shall have the authority to adopt rules neces-
14 sary to implement the duties and responsibilities assigned to the medicaid
15 fraud control unit under this section.
16 (10) As used in this section:
17 (a) "Board and care facility" means a provider of medicaid services in a
18 residential setting which receives payment from or on behalf of two (2) or
19 more unrelated adults who reside in such facility, and for whom one (1) or
20 more of the following is provided:
21 (i) Nursing care services provided by, or under the supervision of,
22 a registered nurse, licensed practical nurse or certified nurses
23 aide; or
24 (ii) A substantial amount of personal care services that assist res-
25 idents with the activities of daily living, including personal
26 hygiene, dressing, bathing, eating, toileting, ambulation, transfer
27 of positions, self-medication, body care, travel to medical services,
28 essential shopping, meal preparation, laundry and housework.
29 (b) "Department" means the Idaho department of health and welfare.
30 (c) "Director" means the director of the Idaho department of health and
31 welfare.
32 (d) "Medicaid" means Idaho's medical assistance program.
33 (e) "Provider" means any individual, partnership, association, corpora-
34 tion or organization, public or private, which provides residential or
35 assisted living services, certified family home services, nursing facility
36 services or services offered pursuant to medical assistance.
37 (f) "Recipient" means an individual determined eligible by the director
38 for the services provided in the state plan for medicaid.
39 (g) "State plan" means the Idaho state plan pursuant to subchapter XIX,
40 chapter 7, title 42 U.S.C.
41 SECTION 5. That Section 56-227, Idaho Code, be, and the same is hereby
42 amended to read as follows:
43 56-227. FRAUDULENT ACTS -- PENALTY. (a) Whoever knowingly obtains, or
44 attempts to obtain, or aids or abets any person in obtaining, by means of a
45 willfully false statement or representation, material omission, or fraudulent
46 devices, public assistance, relief or federal-aid assistance to which he is
47 not entitled, or in an amount greater than that to which he is justly enti-
48 tled, shall be punished in the same manner and to the same extent as for lar-
49 ceny or theft of the money or value of the public assistance so obtained or
50 attempted to be so obtained.
51 (b) Whoever sells, conveys, mortgages or otherwise disposes of his prop-
52 erty, real or personal, or conceals his income or resources, for the purpose
53 of rendering him eligible for any form of assistance, theretofore or thereaf-
9
1 ter applied for, to which he would not otherwise be entitled, shall be pun-
2 ished in the same manner and to the same extent as for larceny or theft of the
3 money or value of the assistance so obtained or so attempted to be obtained.
4 (c) Every person who knowingly aids or abets any person in selling, con-
5 veying, mortgaging or otherwise disposing of his property, real or personal,
6 or in concealing his income or resources for the purpose of rendering him
7 eligible for any form of public assistance or relief, theretofore or thereaf-
8 ter applied for and received, to which he would not otherwise be entitled,
9 shall be punished in the same manner and to the same extent as for larceny or
10 theft of the money or value of the public assistance or relief so obtained or
11 attempted to be obtained.
12 (d) For the purpose of this section federal-aid assistance shall include
13 the specific categories of assistance for which provision is made in any fed-
14 eral law existing or hereafter enacted by the congress of the United States by
15 which payments are made from the federal government to the state in aid or in
16 respect to payment by the state for welfare purposes to any category of needy
17 person and any other program of assistance for which provision for federal
18 funds for aid may from time to time be made.
19 (e) The state department of health and welfare shall establish and oper-
20 ate a fraud control program as permitted by section 416 of the social security
21 act as now or hereafter amended.
22 SECTION 6. That Section 56-227B, Idaho Code, be, and the same is hereby
23 amended to read as follows:
24 56-227B. PROVIDER FRAUD -- DAMAGES. Any provider who knowingly with
25 intent to defraud by means of false statement or representation, obtains com-
26 pensation from public funds greater than that to which he is legally entitled
27 for services or supplies furnished or purportedly furnished shall be liable
28 for civil damages equal to three (3) times the amount by which any figure is
29 falsely overstated. The director of the department of health and welfare or
30 the attorney general shall have the right to cause legal action to be taken
31 for the recovery of such damages when persuaded that a reimbursement claim for
32 payment is falsely overstated. The burden of proof for such recovery action
33 shall be that which is used in other civil actions for the recovery of dam-
34 ages. The remedy provided by this section shall be in addition to any other
35 remedy provided by law.
36 If any provider of services or supplies is required to refund or repay all
37 or part of any payment received by said provider under the provisions of this
38 section, said refund or repayment shall bear interest from the date payment
39 was made to such provider to the date of said refund or repayment. Interest
40 shall accrue at the rate of ten per cent percent (10%) per annum. If, as a
41 result of such The prevailing party in an action, the provider of services or
42 supplies is not required to refund or repay any payment received by said pro-
43 vider under the terms of this section, shall be awarded costs and reasonable
44 attorney's fees shall be allowed the provider incurred in bringing or defend-
45 ing the action. Notwithstanding any other provision of the Idaho Code, all
46 costs and attorney's fees awarded to the department of health and welfare or
47 the attorney general pursuant to this section shall be deposited into the
48 state general fund.
49 SECTION 7. That Section 56-227C, Idaho Code, be, and the same is hereby
50 amended to read as follows:
51 56-227C. SUBPOENA POWER. (1) The director, or his authorized representa-
10
1 tive, and the director of the Idaho state police, or his authorized represen-
2 tative, and any prosecuting attorney of any county, for the purposes contem-
3 plated by this act, have power to issue subpoenas, compel the attendance of
4 witnesses, administer oaths, certify to official acts, take depositions within
5 and without the state of Idaho, as now provided by law, compel the production
6 of pertinent books, payrolls, accounts, papers, records, documents and testi-
7 mony. If a person in attendance before such director or his authorized repre-
8 sentative or prosecuting attorney refuses, without reasonable cause, to be
9 examined or to answer a legal and pertinent question, or to produce a book or
10 paper or other evidence when ordered so to do by the director or his autho-
11 rized representative, or prosecuting attorney, said director or his authorized
12 representative or prosecuting attorney may apply to the judge of the district
13 court of the county where such person is in attendance, upon affidavit for an
14 order returnable in not less than two (2) or more than five (5) days, direct-
15 ing such person to show cause before such judge, or any other judge of such
16 district, why he should not be punished for contempt; upon the hearing of such
17 order, if the judge shall determine that such person has refused, without rea-
18 sonable cause or legal excuse, to be examined or to answer a legal or perti-
19 nent question, or to produce a book or paper which he was ordered to bring or
20 produce, he may forthwith punish the offender as for contempt of court.
21 (a) No If any person shall asks to be excused from attending or testify-
22 ing or from producing any books, or payrolls, accounts, papers, records,
23 or documents or other evidence in connection with any investigation or
24 inquiry by or upon any hearing before any officer so authorized upon pur-
25 suant to this subsection (1), or in any proceeding or action before any
26 court upon a charge or violation of this subsection (1), on the ground
27 that the testimony or evidence, books, papers or documents required of him
28 may tend to incriminate him or subject him to penalty or forfeiture; but
29 no person shall be prosecuted, punished or subjected to any penalty or
30 forfeiture for or on account of any act, transaction, matter or thing con-
31 cerning which he is compelled, after claiming his privileges against self-
32 incrimination, to testify or produce evidence, documentary or otherwise,
33 except that any person so testifying shall not be exempt from prosecution
34 and punishment for perjury committed in so testifying, and if such person,
35 notwithstanding such request, is directed to give such testimony or pro-
36 duce such evidence, the person must, if so directed by the director or his
37 authorized representative, comply with such direction.
38 (b) After complying, and if, but for this subsection (1), the person
39 would have been privileged to withhold the answer given or the evidence
40 produced by him, then the answer, the evidence and any information
41 directly or indirectly derived from the answer or evidence, may not be
42 used against the compelled person in any manner in a criminal case, except
43 that the person may nevertheless be prosecuted or subjected to penalty or
44 forfeiture for any perjury, false swearing or contempt committed in
45 answering or failing to answer or in producing or failing to produce evi-
46 dence in accordance with the order. Such evidence may be used in the
47 refusal, suspension or revocation of any license, permission or authority
48 conferred, or to be conferred, pursuant to Idaho Code.
49 (2) The attorney general or any prosecuting attorney or the designated
50 agent of either shall have the authority to issue subpoenas to an enrolled or
51 formerly enrolled provider of services pursuant to the medicaid program to
52 compel production of any books, payrolls, accounts, papers, records or docu-
53 ments that are required to be maintained under the medicaid provider agreement
54 executed by such provider or formerly enrolled provider as may be relevant to
55 an investigation of fraud or other crime directly related to the use of medic-
11
1 aid program funds or services provided through the medicaid program that are
2 not already in the possession of the director of the department of health and
3 welfare or his designated agent. The attorney general or any prosecuting
4 attorney or the designated agent of either may also compel testimony by the
5 custodian of the items subpoenaed concerning the production and authenticity
6 of those items. Subpoenas for records or information which are not required to
7 be maintained under a provider agreement shall only be issued through subpoena
8 powers in judicial proceedings. A subpoena under this subsection (2) shall
9 describe the items required to be produced with particularity and prescribe a
10 return date of a reasonable period of time within which the items can be
11 assembled and made available to the attorney general or any prosecuting attor-
12 ney or the designated agent of either.
13 (3) Subpoenas issued pursuant to this section shall be served and witness
14 fees and mileage paid as allowed in civil cases in the district courts of this
15 state.
16 (4) Inspectors and iInvestigators employed by the Idaho state police
17 attorney general for the enforcement of this act investigation and prosecution
18 of providers of services pursuant to the medicaid program shall have all the
19 authority given by statute to peace officers of the state of Idaho, including,
20 but not limited to, authority to obtain, serve and execute warrants of arrest
21 and warrants of search and seizure.
22 SECTION 8. That Section 56-227D, Idaho Code, be, and the same is hereby
23 amended to read as follows:
24 56-227D. FEDERAL FOOD STAMPS -- UNAUTHORIZED USE -- EXCEPTION -- DEFINI-
25 TION. (a1) It is a misdemeanor for any person to buy, receive, sell, give
26 away, dispose of, exchange or barter any federal food stamps of a value of one
27 hundred fifty dollars ($150) or less, except for the eligible foods for which
28 they are issued.
29 (b2) It is a felony for any person to buy, receive, sell, give away, dis-
30 pose of, exchange or barter any federal food stamps of a value exceeding one
31 hundred fifty dollars ($150), except for the eligible foods for which they are
32 issued.
33 (c3) This section does not apply to any person buying, receiving, sell-
34 ing, giving away, disposing of, exchanging or bartering any federal food
35 stamps subsequent to the redemption of such stamps in the manner provided by
36 state or federal law.
37 (d4) As used in this section, federal food stamps refers to stamps issued
38 for food by the United States department of agriculture or its duly authorized
39 agent.
40 (5) This section shall be enforced by the director of the department of
41 health and welfare in cooperation with local law enforcement and prosecuting
42 agencies. Such enforcement shall not be the responsibility of the medicaid
43 fraud control unit as provided in section 56-226, Idaho Code.
44 SECTION 9. That Chapter 2, Title 56, Idaho Code, be, and the same is
45 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
46 ignated as Section 56-227E, Idaho Code, and to read as follows:
47 56-227E. OBSTRUCTION OF INVESTIGATION. (1) An obstruction of investiga-
48 tion consists of knowingly:
49 (a) Providing false information to, or knowingly withholding information
50 from, any person requesting such information if that person is authorized
51 to investigate a violation of this chapter or to enforce the criminal or
12
1 civil remedies of this chapter where that information is properly
2 requested and is material to the investigation or enforcement; or
3 (b) Altering any document or record required to be retained pursuant to
4 this chapter or any rule issued by the department of health and welfare,
5 when the alteration is intended to mislead an investigation and concerns
6 information material to that investigation.
7 (2) Whoever commits an obstruction of investigation shall be guilty of a
8 felony and shall be sentenced pursuant to the provisions of section 18-112,
9 Idaho Code.
10 SECTION 10. That Section 67-1401, Idaho Code, be, and the same is hereby
11 amended to read as follows:
12 67-1401. DUTIES OF ATTORNEY GENERAL. Except as otherwise provided in this
13 chapter, it is the duty of the attorney general:
14 (1.) To perform all legal services for the state and to represent the
15 state and all departments, agencies, offices, officers, boards, commissions,
16 institutions and other state entities, in all courts and before all adminis-
17 trative tribunals or bodies of any nature. Representation shall be provided to
18 those entities exempted pursuant to the provisions of section 67-1406, Idaho
19 Code. Whenever required to attend upon any court or administrative tribunal
20 the attorney general shall be allowed necessary and actual expenses, all
21 claims for which shall be audited by the state board of examiners.
22 (2.) To advise all departments, agencies, offices, officers, boards, com-
23 missions, institutions and other state entities in all matters involving ques-
24 tions of law.
25 (3.) After judgment in any of the causes referred to in the first subdi-
26 vision, to direct the issuing of such process as may be necessary to carry the
27 same into execution.
28 (4.) To account for and pay over to the proper officer all moneys
29 received which belong to the state.
30 (5.) To supervise nonprofit corporations, corporations, charitable or
31 benevolent societies, person or persons holding property subject to any public
32 or charitable trust and to enforce whenever necessary any noncompliance or
33 departure from the general purpose of such trust and, in order to accomplish
34 such purpose, said nonprofit corporations, corporations, charitable or benevo-
35 lent societies, person or persons holding property subject to any public or
36 charitable trust are subject at all times to examination by the attorney gen-
37 eral, on behalf of the state, to ascertain the condition of its affairs and to
38 what extent, if at all, said trustee or trustees may have failed to comply
39 with trusts said trustee or trustees have assumed or may have departed from
40 the general purpose for which it was formed. In case of any such failure or
41 departure, the attorney general shall institute, in the name of the state, any
42 proceeding necessary to enforce compliance with the terms of the trust or any
43 departure therefrom.
44 (6.) To give an opinion in writing, without fee, to the legislature or
45 either house thereof, or any senator or representative, and to the governor,
46 secretary of state, treasurer, state controller, and the superintendent of
47 public instruction, when requested, upon any question of law relating to their
48 respective offices. The attorney general shall keep a record of all written
49 opinions rendered by the office and such opinions shall be compiled annually
50 and made available for public inspection. All costs incurred in the prepara-
51 tion of said opinions shall be borne by the office of the attorney general. A
52 copy of the opinions shall be furnished to the supreme court and to the state
53 librarian.
13
1 (7.) When required by the public service, to repair to any county in the
2 state and assist the prosecuting attorney thereof in the discharge of duties.
3 (8.) To bid upon and purchase, when necessary, in the name of the state,
4 and under the direction of the state controller, any property offered for sale
5 under execution issued upon judgments in favor of or for the use of the state,
6 and to enter satisfaction in whole or in part of such judgments as the consid-
7 eration for such purchases.
8 (9.) Whenever the property of a judgment debtor in any judgment mentioned
9 in the preceding subdivision has been sold under a prior judgment, or is sub-
10 ject to any judgment, lien, or encumbrance, taking precedence of the judgment
11 in favor of the state, under the direction of the state controller, to redeem
12 such property from such prior judgment, lien, or encumbrance; and all sums of
13 money necessary for such redemption must, upon the order of the board of exam-
14 iners, be paid out of any money appropriated for such purposes.
15 (10.) When necessary for the collection or enforcement of any judgment
16 hereinbefore mentioned, to institute and prosecute, in behalf of the state,
17 such suits or other proceedings as may be necessary to set aside and annul all
18 conveyances fraudulently made by such judgment debtors; the cost necessary to
19 the prosecution must, when allowed by the board of examiners, be paid out of
20 any appropriations for the prosecution of delinquents.
21 (11.) To exercise all the common law power and authority usually apper-
22 taining to the office and to discharge the other duties prescribed by law.
23 (12.) To report to the governor, at the time required by this code, the
24 condition of the affairs of the attorney general's office and of the reports
25 received from prosecuting attorneys.
26 (13.) To appoint deputy attorneys general and special deputy attorneys
27 general and other necessary staff to assist in the performance of the duties
28 of the office. Such deputies and staff shall be nonclassified employees within
29 the meaning of section 67-5302, Idaho Code.
30 (14) To establish a medicaid fraud control unit pursuant to the provi-
31 sions of section 56-226, Idaho Code, and to exercise concurrent investigative
32 and prosecutorial authority and responsibility with county prosecutors to
33 prosecute persons for the violation of the criminal provisions of chapter 2,
34 title 56, Idaho Code, and for criminal offenses that are not defined in said
35 chapter 2, title 56, Idaho Code, but that involve or are directly related to
36 the use of medicaid program funds or services provided through the medicaid
37 program.
14
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 166, As Amended
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAID; AMENDING SECTION 15-8-103, IDAHO CODE, TO MAKE A TECHNI-
3 CAL CORRECTION; AMENDING SECTION 56-209h, IDAHO CODE, TO DEFINE A TERM, TO
4 PROVIDE FOR A MEDICAID FRAUD PROGRAM IN THE DEPARTMENT OF HEALTH AND WEL-
5 FARE AND THE SCOPE OF SUCH PROGRAM, TO REMOVE A TIME REQUIREMENT, TO
6 REMOVE A CONDITION FOR ACTION, TO PROVIDE FOR ACTION UPON REFERRAL, TO
7 PROVIDE REFERRAL AND COMPLIANCE REQUIREMENTS, TO PROVIDE FOR A MINIMUM FOR
8 COST RECOVERY AND TO MAKE A TECHNICAL CORRECTION; AMENDING CHAPTER 2,
9 TITLE 56, IDAHO CODE, BY THE ADDITION OF NEW SECTIONS 56-209o AND 56-226,
10 IDAHO CODE, TO PROVIDE FOR RECORD RETENTION REQUIREMENTS, TO PROVIDE FOR
11 CRIMINAL PENALTIES, TO ESTABLISH IN THE OFFICE OF THE ATTORNEY GENERAL THE
12 MEDICAID FRAUD CONTROL UNIT, TO PROVIDE THE DUTIES, AUTHORITY AND RESPON-
13 SIBILITIES OF THE UNIT, TO PROVIDE EXCLUSIVE CONTROL OF THE UNIT AND TO
14 DEFINE TERMS; AMENDING SECTION 56-227, IDAHO CODE, TO REMOVE A REQUIREMENT
15 FOR THE DEPARTMENT OF HEALTH AND WELFARE TO ESTABLISH AND OPERATE A FRAUD
16 CONTROL PROGRAM; AMENDING SECTION 56-227B, IDAHO CODE, TO PROVIDE FOR THE
17 RIGHT OF THE ATTORNEY GENERAL TO CAUSE CERTAIN LEGAL ACTION TO BE UNDER-
18 TAKEN, TO PROVIDE FOR COSTS AND REASONABLE ATTORNEY'S FEES TO BE AWARDED
19 TO THE PREVAILING PARTY, TO PROVIDE FOR THE DISPOSITION OF COSTS AND
20 ATTORNEY'S FEES AND TO MAKE A TECHNICAL CORRECTION; AMENDING SECTION
21 56-227C, IDAHO CODE, TO REQUIRE PERSONS ASKING TO BE EXCUSED FROM ATTEND-
22 ING, PRODUCING OR TESTIFYING ON THE GROUNDS OF SELF-INCRIMINATION TO COM-
23 PLY WITH THE REQUEST, TO PROVIDE FOR THE USE OF INFORMATION PROVIDED BY
24 PERSONS PRIVILEGED TO WITHHOLD INFORMATION, TO PROVIDE AUTHORITY TO THE
25 ATTORNEY GENERAL AND ANY PROSECUTING ATTORNEY TO ISSUE SUBPOENAS AND COM-
26 PEL TESTIMONY FROM CUSTODIANS, TO PROVIDE SUBPOENA REQUIREMENTS, TO PRO-
27 VIDE PROCEDURE AND GROUNDS FOR MODIFYING OR QUASHING A SUBPOENA AND TO
28 PROVIDE PEACE OFFICER STATUS TO INVESTIGATORS EMPLOYED BY THE ATTORNEY
29 GENERAL; AMENDING SECTION 56-227D, IDAHO CODE, TO PROVIDE ENFORCEMENT
30 AUTHORITY TO THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WELFARE, TO PRO-
31 VIDE THAT SUCH ENFORCEMENT IS NOT THE RESPONSIBILITY OF THE MEDICAID FRAUD
32 UNIT AND TO MAKE TECHNICAL CORRECTIONS; AMENDING CHAPTER 2, TITLE 56,
33 IDAHO CODE, BY THE ADDITION OF A NEW SECTION 56-227E, IDAHO CODE, TO PRO-
34 VIDE A DESCRIPTION OF OBSTRUCTION OF INVESTIGATION AND TO PROVIDE CRIMINAL
35 PENALTIES; AND AMENDING SECTION 67-1401, IDAHO CODE, TO REVISE DUTIES OF
36 THE ATTORNEY GENERAL AND TO MAKE TECHNICAL CORRECTIONS.
37 Be It Enacted by the Legislature of the State of Idaho:
38 SECTION 11. That Section 15-8-103, Idaho Code, be, and the same is hereby
39 amended to read as follows:
40 15-8-103. DEFINITIONS. The definitions in this section apply throughout
41 this chapter unless the context clearly requires otherwise:
42 (1) "Matter" includes any issue, question or dispute involving:
43 (a) The determination of any class of creditors, devisees, legatees,
44 heirs, next of kin, or other persons interested in an estate, trust,
45 nonprobate asset, or with respect to any other asset or property interest
46 passing at death;
15
1 (b) The direction of a personal representative or trustee to do or to
2 abstain from doing any act in a fiduciary capacity;
3 (c) The determination of any question arising in the administration of an
4 estate or trust, or with respect to any nonprobate asset, or with respect
5 to any other asset or property interest passing at death, that may
6 include, without limitation, questions relating to:
7 (i) The construction of wills, trusts, devolution agreements, and
8 other writings;
9 (ii) A change of personal representative or trustee;
10 (iii) A change of the situs of a trust;
11 (iv) An accounting from a personal representative or trustee; or
12 (v) The determination of fees for a personal representative or
13 trustee;
14 (d) The grant to a personal representative or trustee of any necessary or
15 desirable power not otherwise granted in the governing instrument or given
16 by law;
17 (e) The amendment, reformation, or conformation of a will or a trust
18 instrument to comply with statutes and regulations of the United States
19 internal revenue service in order to more efficiently allocate exemptions
20 or to achieve qualification for deductions, elections, and other tax
21 requirements including, but not limited to, the qualification of any gift
22 thereunder for the benefit of a surviving spouse who is not a citizen of
23 the United States for the estate tax marital deduction permitted by fed-
24 eral law, including the addition of mandatory governing instrument
25 requirements for a qualified domestic trust under section 2056A of the
26 Internal Revenue Code, the qualification of any gift thereunder as a qual-
27 ified conservation easement as permitted by federal law, or the qualifica-
28 tion of any gift for the charitable estate tax deduction permitted by fed-
29 eral law, including the addition of mandatory governing instrument
30 requirements for a charitable remainder trust; and
31 (f) With respect to any nonprobate asset, or with respect to any other
32 asset or property interest passing at death, including actual joint ten-
33 ancy property, property subject to a devolution agreement, or assets sub-
34 ject to a pay on death or transfer on death designation:
35 (i) The ascertaining of any class of creditors or others for pur-
36 poses of section 15-6-107, Idaho Code;
37 (ii) The ordering of a custodian of any of the decedent's records
38 relating to a nonprobate asset to do or abstain from doing any par-
39 ticular act with respect to those records;
40 (iii) The determination of any question arising in the administration
41 of a nonprobate asset under section 15-6-107, Idaho Code;
42 (iv) The determination of any questions relating to the abatement,
43 rights of creditors, or other matter relating to the administration,
44 settlement, or final disposition of a nonprobate asset under title
45 15, Idaho Code; and
46 (v) The resolution of any matter referencing this chapter, includ-
47 ing a determination of any questions relating to the ownership or
48 distribution of an individual retirement account on the death of the
49 spouse of the account holder as contemplated by section 11-604A(6),
50 Idaho Code;
51 (g) The resolution of any other matter that could affect the nonprobate
52 asset.
53 (2) "Nonprobate assets" means assets that are covered by chapter 6, title
54 15, Idaho Code.
55 (3) "Party" or "parties" means each of the following persons who has an
16
1 interest in the subject of the particular proceeding and whose name and
2 address are known to, or are reasonably ascertainable by, the petitioner:
3 (a) The trustor if living;
4 (b) The trustee;
5 (c) The personal representative;
6 (d) An heir;
7 (e) A beneficiary, including devisees, legatees, and trust beneficiaries;
8 (f) The surviving spouse of a decedent with respect to his or her inter-
9 est in the decedent's property;
10 (g) A guardian ad litem;
11 (h) A creditor;
12 (i) Any other person who has an interest in the subject of the particular
13 proceeding;
14 (j) The attorney general if required under section 67-1401(5.), Idaho
15 Code;
16 (k) Any duly appointed and acting legal representative of a party such as
17 a guardian, conservator, special representative, or attorney in fact;
18 (l) Where applicable, the virtual representative of any person described
19 in this subsection (3), the giving of notice to whom would meet notice
20 requirements as provided in section 15-8-204, Idaho Code; and
21 (m) The owner or the personal representative of the estate of the
22 deceased owner of the nonprobate asset that is the subject of the particu-
23 lar proceeding, if the subject of the particular proceeding relates to the
24 beneficiary's liability to a decedent's estate or creditors under section
25 15-6-107, Idaho Code.
26 (4) "Persons interested in the estate or trust" means the trustor, if
27 living, all persons beneficially interested in the estate or trust, persons
28 holding powers over the trust or estate assets, the attorney general in the
29 case of any charitable trust where the attorney general would be a necessary
30 party to judicial proceedings concerning the trust, and any personal represen-
31 tative or trustee of the estate or trust.
32 (5) "Representative" and other similar terms refer to a person who virtu-
33 ally represents another person under section 15-8-205, Idaho Code.
34 (6) "Trustee" means any acting and qualified trustee of the trust.
35 SECTION 12. That Section 56-209h, Idaho Code, be, and the same is hereby
36 amended to read as follows:
37 56-209h. ADMINISTRATIVE REMEDIES. (1) Definitions. For purposes of this
38 section:
39 (a) "Abuse" or "abusive" means provider practices that are inconsistent
40 with sound fiscal, business, or medical practices, and result in an unnec-
41 essary cost to the medical assistance program, in reimbursement for ser-
42 vices that are not medically necessary or that fail to meet professionally
43 recognized standards for health care, or in physical harm, pain or mental
44 anguish to a medical assistance recipient.
45 (b) "Claim" means any request or demand for payment of items or services
46 under the state's medical assistance program, whether under a contract or
47 otherwise.
48 (c) "Fraud" or "Ffraudulent" means an intentional deception or misrepre-
49 sentation made by a person with the knowledge that the deception could
50 result in some unauthorized benefit to himself or some other person.
51 (d) "Knowingly," "known" or "with knowledge" means that a person, with
52 respect to information or an action:
53 (i) Has actual knowledge of the information or action; or
17
1 (ii) Acts in deliberate ignorance of the truth or falsity of the
2 information or the correctness or incorrectness of the action; or
3 (iii) Acts in reckless disregard of the truth or falsity of the
4 information or the correctness or incorrectness of the action.
5 (e) "Managing employee" means a general manager, business manager, admin-
6 istrator, director or other individual who exercises operational or mana-
7 gerial control over, or who directly or indirectly conducts the day-to-day
8 operation of, an institution, organization or agency.
9 (f) "Medicaid fraud control unit" means that medicaid fraud control unit
10 as provided for in section 56-226, Idaho Code.
11 (g) "Ownership or control interest" means a person or entity that:
12 (i) Has an ownership interest totaling twenty-five percent (25%) or
13 more in an entity; or
14 (ii) Is an officer or director of an entity that is organized as a
15 corporation; or
16 (iii) Is a partner in an entity that is organized as a partnership;
17 or
18 (iv) Is a managing member in an entity that is organized as a lim-
19 ited liability company.
20 (2) The department shall establish and operate an administrative fraud
21 control program to enforce violations of the provisions of this chapter and of
22 the state plan pursuant to subchapters XIX and XXI, chapter 7, title 42,
23 U.S.C., that are outside the scope of the duties of the medicaid fraud control
24 unit and to render and receive referrals from and to said unit.
25 (3) Review of dDocumentation of services. All claims submitted by
26 providers for payment are subject to prepayment and postpayment review as des-
27 ignated by rule. Except as otherwise provided by rule, providers shall gener-
28 ate documentation at the time of service sufficient to support each claim. and
29 shall retain the documentation for a minimum of five (5) years from the date
30 the item or service was provided. The department or authorized agent shall be
31 given immediate access to such documentation upon written request.
32 (34) Immediate action. In the event that the department identifies a sus-
33 pected case of fraud or abuse, and the department has reason to believe that
34 payments made during the investigation may be difficult or impractical to
35 recover, the department may suspend or withhold payments to the provider pend-
36 ing investigation. In the event that the department identifies a suspected
37 case of fraud or abuse and it determines that it is necessary to prevent or
38 avoid immediate danger to the public health or safety, the department may sum-
39 marily suspend a provider agreement pending investigation. When payments have
40 been suspended or withheld or a provider agreement suspended pending investi-
41 gation, the department shall provide for a hearing within thirty (30) days of
42 receipt of any duly filed notice of appeal.
43 (45) Recovery of payments. Upon referral of a matter from the medicaid
44 fraud control unit, or iIf it is determined by the department that any condi-
45 tion of payment contained in rule, regulation, statute, or provider agreement
46 was not met, the department may initiate administrative proceedings to recover
47 any payments made for items or services. Interest shall accrue on overpayments
48 at the statutory rate set forth in section 28-22-104, Idaho Code, from the
49 date of final determination of the amount owed for items or services until the
50 date of recovery.
51 (56) Provider status. The department may terminate the provider agreement
52 or otherwise deny provider status to any individual or entity who:
53 (a) Submits a claim with knowledge that the claim is incorrect, including
54 reporting costs as allowable which were known to be disallowed in a previ-
55 ous audit, unless the provider clearly indicates that the item is being
18
1 claimed to establish the basis for an appeal and each disputed item and
2 amount is specifically identified; or
3 (b) Submits a fraudulent claim; or
4 (c) Knowingly makes a false statement or representation of material fact
5 in any document required to be maintained or submitted to the department;
6 or
7 (d) Submits a claim for an item or service known to be medically unneces-
8 sary; or
9 (e) Fails to provide, upon written request by the department, immediate
10 access to documentation required to be maintained; or
11 (f) Fails repeatedly or substantially to comply with the rules and regu-
12 lations governing medical assistance payments; or
13 (g) Knowingly violates any material term or condition of its provider
14 agreement; or
15 (h) Has failed to repay, or was a "managing employee" or had an
16 "ownership or control interest" in any entity that has failed to repay,
17 any overpayments or claims previously found to have been obtained contrary
18 to statute, rule, regulation or provider agreement; or
19 (i) Has been found, or was a "managing employee" in any entity which has
20 been found, to have engaged in fraudulent conduct or abusive conduct in
21 connection with the delivery of health care items or services; or
22 (j) Fails to meet the qualifications specifically required by rule or by
23 any applicable licensing board.
24 Any individual or entity denied provider status under this section may be pre-
25 cluded from participating as a provider in the medical assistance program for
26 up to five (5) years from the date the department's action becomes final.
27 (7) The department must refer all cases of suspected fraud to the medic-
28 aid fraud control unit and shall promptly comply with any request from the
29 medicaid fraud control unit for access to and free copies of any records or
30 information kept by the department or its contractors, computerized data
31 stored by the department or its contractors, and any information kept by
32 providers to which the department is authorized access by law.
33 (68) Civil monetary penalties. The department may also assess civil mone-
34 tary penalties against a provider and any officer, director, owner, and/or
35 managing employee of a provider for conduct identified in subsections (56)(a)
36 through (56)(i) of this section. The amount of the penalties shall be up to
37 one thousand dollars ($1,000) for each item or service improperly claimed,
38 except that in the case of multiple penalties the department may reduce the
39 penalties to not less than twenty-five percent (25%) of the amount of each
40 item or service improperly claimed if an amount can be readily determined.
41 Each line item of a claim, or cost on a cost report is considered a separate
42 claim. These penalties are intended to be remedial, recovering at a minimum
43 costs of investigation and administrative review, and placing the costs asso-
44 ciated with noncompliance on the offending provider.
45 (79) Exclusion. Any individual or entity convicted of a criminal offense
46 related to the delivery of an item or service under any state or federal pro-
47 gram shall be excluded from program participation for a period of not less
48 than ten (10) years. Unless otherwise provided in this section or required by
49 federal law, the department may exclude any individual or entity for a period
50 of not less than one (1) year for any conduct for which the secretary of the
51 department of health and human services or designee could exclude an individ-
52 ual or entity.
53 (810) Adoption of rules. The department shall promulgate such rules as are
54 necessary to carry out the policies and purposes of this section.
19
1 SECTION 13. That Chapter 2, Title 56, Idaho Code, be, and the same is
2 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
3 ignated as Section 56-209o, Idaho Code, and to read as follows:
4 56-209o. FAILURE TO RETAIN RECORDS. (1) Whoever receives payment for
5 treatment, services or goods under the provisions of this chapter or under the
6 state plan pursuant to subchapter XIX or XXI, chapter 7, title 42, U.S.C.,
7 shall retain for a period of at least five (5) years all medical and business
8 records relating to:
9 (a) The treatment or care of any recipient;
10 (b) Services or goods provided to any recipient;
11 (c) Rates paid by the department under the program on behalf of any
12 recipient; and
13 (d) Any records required to be maintained by rule of the department for
14 administration of the medicaid program.
15 (2) It shall be unlawful with an intent to evade or avoid the provisions
16 of this act: to fail to retain the records specified in subsection (1) of this
17 section for a period of at least five (5) years from the date payment was
18 claimed or received, whichever is later; or to knowingly destroy or cause the
19 records specified in subsection (1) of this section to be destroyed within
20 five (5) years from the date payment was claimed or received, whichever is
21 later. Any person who, with an intent to evade or avoid the provisions of this
22 act, fails to retain records or destroys records or causes records to be
23 destroyed as provided in this subsection (2), with an intent to evade or avoid
24 the provisions of this act, shall be subject to the following criminal sanc-
25 tions:
26 (a) If the treatment, services or goods for which records were not
27 retained or for which records were destroyed amount to not more than one
28 thousand dollars ($1,000), the person shall be guilty of a misdemeanor and
29 shall be sentenced pursuant to section 18-113, Idaho Code.
30 (b) If the value of the treatment, services or goods for which records
31 were not retained or for which records were destroyed is more than one
32 thousand dollars ($1,000), the person shall be guilty of a felony and
33 shall be sentenced pursuant to section 18-112, Idaho Code.
34 (c) If the records not retained or destroyed were used in whole or in
35 part to determine a rate of payment under the program, the person shall be
36 guilty of a misdemeanor and shall be sentenced pursuant to section 18-113,
37 Idaho Code.
38 SECTION 14. That Chapter 2, Title 56, Idaho Code, be, and the same is
39 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
40 ignated as Section 56-226, Idaho Code, and to read as follows:
41 56-226. MEDICAID FRAUD CONTROL UNIT. (1) There is hereby established in
42 the office of the attorney general the medicaid fraud control unit which shall
43 have the authority and responsibilities as set forth in this section.
44 (2) Notwithstanding the authority and responsibility granted to the
45 director of the department to provide for fraud control in other aspects of
46 public assistance and public health programs, the medicaid fraud control unit
47 shall have the authority and responsibility to conduct a statewide program for
48 the investigation and prosecution of violations of all applicable Idaho laws
49 pertaining to fraud in the administration of the medicaid program, the provi-
50 sion of medical assistance and in the activities of providers of medical
51 assistance and services under the state plan. Further, upon approval of the
52 inspector general of the relevant federal agency, the office of the attorney
20
1 general shall have the authority and responsibility to investigate and to
2 prosecute violations of any aspect of the provision of health care services
3 and activities of providers of such services under any federal health care
4 program as defined in 42 U.S.C. section 1320(a)-7b(f)1, if the suspected fraud
5 or violation of law in such investigation or prosecution is substantially
6 related to the state plan. The medicaid fraud control unit shall be under the
7 exclusive control of the attorney general and be separate and distinct from
8 the department. No official from the department shall have authority to review
9 or override the prosecutorial decisions made by the medicaid fraud control
10 unit.
11 (3) The medicaid fraud control unit shall also:
12 (a) Review complaints of abuse or neglect of medicaid recipients in
13 health care facilities which receive payment pursuant to the state plan
14 and may review complaints of the misappropriation of patients' private
15 funds in such facilities; and
16 (b) Review complaints of abuse or neglect of medicaid recipients residing
17 in a board and care facility.
18 (4) The medicaid fraud control unit shall attempt to collect or refer to
19 the department for collection overpayments that are made to providers of
20 facilities under the state plan or under any federal health care program to
21 health care facilities that are the result of fraudulent acts and that are
22 discovered by the medicaid fraud control unit in carrying out its responsibil-
23 ities under this section. Notwithstanding any other provision of Idaho Code,
24 all funds collected by the medicaid fraud control unit in accordance with this
25 subsection (4) shall be deposited into the state general fund.
26 (5) The office of the attorney general shall employ such auditors, attor-
27 neys, investigators and other personnel as are necessary to carry out the
28 responsibilities of the medicaid fraud control unit as set forth under this
29 section.
30 (6) The office of the attorney general shall submit to the secretary of
31 the federal department of health and human services applications and reports
32 containing such information as is determined by the secretary by regulation to
33 be necessary to meet the requirements of subchapter XIX, chapter 7, title 42,
34 U.S.C.
35 (7) In carrying out its duties and responsibilities under this section,
36 the medicaid fraud control unit may:
37 (a) Request and receive the assistance of any prosecutor or law enforce-
38 ment agency in the investigation and prosecution of any violation of any
39 applicable Idaho laws pertaining to fraud in the administration of the
40 medicaid program, the provision of medical assistance and in the activi-
41 ties of providers of medical assistance and services under the state plan;
42 (b) Enter upon the premises of any provider participating in the medicaid
43 program to:
44 (i) Examine all accounts and records that are relevant in determin-
45 ing the existence of fraud in the medicaid program;
46 (ii) Investigate alleged abuse or neglect of medicaid recipients; or
47 (iii) Investigate alleged misappropriation of patients' private
48 funds. The accounts or records of a nonmedicaid recipient may not be
49 reviewed by, or turned over to the medicaid fraud control unit with-
50 out the patient's written consent or a court order; and
51 (c) Notwithstanding any other provision of law, upon written request have
52 full access to all records held by a medicaid provider, or by any other
53 person on his or her behalf, that are relevant to the determination of
54 the:
55 (i) Existence of civil violations or criminal offenses under this
21
1 chapter or related offenses;
2 (ii) Existence of medicaid recipient abuse, mistreatment or neglect;
3 or
4 (iii) Theft of medicaid recipient funds.
5 No person holding such records shall refuse to provide the medicaid fraud
6 control unit access to such records for the purposes described in this
7 section on the basis that release would violate the medicaid recipient's
8 right of privacy or privilege against disclosure or use or any profes-
9 sional or other privilege or right.
10 (8) The medicaid fraud control unit shall safeguard the privacy rights of
11 medicaid recipients to avoid unnecessary disclosure of personal information
12 concerning named medicaid recipients. The medicaid fraud control unit may
13 transmit such information that it deems appropriate to the department and to
14 other agencies concerned with the regulation of health care facilities or
15 health professionals.
16 (9) The attorney general shall have the authority to adopt rules neces-
17 sary to implement the duties and responsibilities assigned to the medicaid
18 fraud control unit under this section.
19 (10) As used in this section:
20 (a) "Board and care facility" means a provider of medicaid services in a
21 residential setting which receives payment from or on behalf of two (2) or
22 more unrelated adults who reside in such facility, and for whom one (1) or
23 more of the following is provided:
24 (i) Nursing care services provided by, or under the supervision of,
25 a registered nurse, licensed practical nurse or certified nurses
26 aide; or
27 (ii) A substantial amount of personal care services that assist res-
28 idents with the activities of daily living, including personal
29 hygiene, dressing, bathing, eating, toileting, ambulation, transfer
30 of positions, self-medication, body care, travel to medical services,
31 essential shopping, meal preparation, laundry and housework.
32 (b) "Department" means the Idaho department of health and welfare.
33 (c) "Director" means the director of the Idaho department of health and
34 welfare.
35 (d) "Medicaid" means Idaho's medical assistance program.
36 (e) "Provider" means any individual, partnership, association, corpora-
37 tion or organization, public or private, which provides residential or
38 assisted living services, certified family home services, nursing facility
39 services or services offered pursuant to medical assistance.
40 (f) "Recipient" means an individual determined eligible by the director
41 for the services provided in the state plan for medicaid.
42 (g) "State plan" means the Idaho state plan pursuant to subchapter XIX,
43 chapter 7, title 42 U.S.C.
44 SECTION 15. That Section 56-227, Idaho Code, be, and the same is hereby
45 amended to read as follows:
46 56-227. FRAUDULENT ACTS -- PENALTY. (a) Whoever knowingly obtains, or
47 attempts to obtain, or aids or abets any person in obtaining, by means of a
48 willfully false statement or representation, material omission, or fraudulent
49 devices, public assistance, relief or federal-aid assistance to which he is
50 not entitled, or in an amount greater than that to which he is justly enti-
51 tled, shall be punished in the same manner and to the same extent as for lar-
52 ceny or theft of the money or value of the public assistance so obtained or
53 attempted to be so obtained.
22
1 (b) Whoever sells, conveys, mortgages or otherwise disposes of his prop-
2 erty, real or personal, or conceals his income or resources, for the purpose
3 of rendering him eligible for any form of assistance, theretofore or thereaf-
4 ter applied for, to which he would not otherwise be entitled, shall be pun-
5 ished in the same manner and to the same extent as for larceny or theft of the
6 money or value of the assistance so obtained or so attempted to be obtained.
7 (c) Every person who knowingly aids or abets any person in selling, con-
8 veying, mortgaging or otherwise disposing of his property, real or personal,
9 or in concealing his income or resources for the purpose of rendering him
10 eligible for any form of public assistance or relief, theretofore or thereaf-
11 ter applied for and received, to which he would not otherwise be entitled,
12 shall be punished in the same manner and to the same extent as for larceny or
13 theft of the money or value of the public assistance or relief so obtained or
14 attempted to be obtained.
15 (d) For the purpose of this section federal-aid assistance shall include
16 the specific categories of assistance for which provision is made in any fed-
17 eral law existing or hereafter enacted by the congress of the United States by
18 which payments are made from the federal government to the state in aid or in
19 respect to payment by the state for welfare purposes to any category of needy
20 person and any other program of assistance for which provision for federal
21 funds for aid may from time to time be made.
22 (e) The state department of health and welfare shall establish and oper-
23 ate a fraud control program as permitted by section 416 of the social security
24 act as now or hereafter amended.
25 SECTION 16. That Section 56-227B, Idaho Code, be, and the same is hereby
26 amended to read as follows:
27 56-227B. PROVIDER FRAUD -- DAMAGES. Any provider who knowingly with
28 intent to defraud by means of false statement or representation, obtains com-
29 pensation from public funds greater than that to which he is legally entitled
30 for services or supplies furnished or purportedly furnished shall be liable
31 for civil damages equal to three (3) times the amount by which any figure is
32 falsely overstated. The director of the department of health and welfare or
33 the attorney general shall have the right to cause legal action to be taken
34 for the recovery of such damages when persuaded that a reimbursement claim for
35 payment is falsely overstated. The burden of proof for such recovery action
36 shall be that which is used in other civil actions for the recovery of dam-
37 ages. The remedy provided by this section shall be in addition to any other
38 remedy provided by law.
39 If any provider of services or supplies is required to refund or repay all
40 or part of any payment received by said provider under the provisions of this
41 section, said refund or repayment shall bear interest from the date payment
42 was made to such provider to the date of said refund or repayment. Interest
43 shall accrue at the rate of ten per cent percent (10%) per annum. If, as a
44 result of such The prevailing party in an action, the provider of services or
45 supplies is not required to refund or repay any payment received by said pro-
46 vider under the terms of this section, shall be awarded costs and reasonable
47 attorney's fees shall be allowed the provider incurred in bringing or defend-
48 ing the action. Notwithstanding any other provision of the Idaho Code, all
49 costs and attorney's fees awarded to the department of health and welfare or
50 the attorney general pursuant to this section shall be deposited into the
51 state general fund.
52 SECTION 17. That Section 56-227C, Idaho Code, be, and the same is hereby
23
1 amended to read as follows:
2 56-227C. SUBPOENA POWER. (1) The director, or his authorized representa-
3 tive, and the director of the Idaho state police, or his authorized represen-
4 tative, and any prosecuting attorney of any county, for the purposes contem-
5 plated by this act, have power to issue subpoenas, compel the attendance of
6 witnesses, administer oaths, certify to official acts, take depositions within
7 and without the state of Idaho, as now provided by law, compel the production
8 of pertinent books, payrolls, accounts, papers, records, documents and testi-
9 mony. If a person in attendance before such director or his authorized repre-
10 sentative or prosecuting attorney refuses, without reasonable cause, to be
11 examined or to answer a legal and pertinent question, or to produce a book or
12 paper or other evidence when ordered so to do by the director or his autho-
13 rized representative, or prosecuting attorney, said director or his authorized
14 representative or prosecuting attorney may apply to the judge of the district
15 court of the county where such person is in attendance, upon affidavit for an
16 order returnable in not less than two (2) or more than five (5) days, direct-
17 ing such person to show cause before such judge, or any other judge of such
18 district, why he should not be punished for contempt; upon the hearing of such
19 order, if the judge shall determine that such person has refused, without rea-
20 sonable cause or legal excuse, to be examined or to answer a legal or perti-
21 nent question, or to produce a book or paper which he was ordered to bring or
22 produce, he may forthwith punish the offender as for contempt of court.
23 (a) No If any person shall asks to be excused from attending or testify-
24 ing or from producing any books, or payrolls, accounts, papers, records,
25 or documents or other evidence in connection with any investigation or
26 inquiry by or upon any hearing before any officer so authorized upon pur-
27 suant to this subsection (1), or in any proceeding or action before any
28 court upon a charge or violation of this subsection (1), on the ground
29 that the testimony or evidence, books, papers or documents required of him
30 may tend to incriminate him or subject him to penalty or forfeiture; but
31 no person shall be prosecuted, punished or subjected to any penalty or
32 forfeiture for or on account of any act, transaction, matter or thing con-
33 cerning which he is compelled, after claiming his privileges against self-
34 incrimination, to testify or produce evidence, documentary or otherwise,
35 except that any person so testifying shall not be exempt from prosecution
36 and punishment for perjury committed in so testifying, and if such person,
37 notwithstanding such request, is directed to give such testimony or pro-
38 duce such evidence, the person must, if so directed by the director or his
39 authorized representative, comply with such direction.
40 (b) After complying, and if, but for this subsection (1), the person
41 would have been privileged to withhold the answer given or the evidence
42 produced by him, then the answer, the evidence and any information
43 directly or indirectly derived from the answer or evidence, may not be
44 used against the compelled person in any manner in a criminal case, except
45 that the person may nevertheless be prosecuted or subjected to penalty or
46 forfeiture for any perjury, false swearing or contempt committed in
47 answering or failing to answer or in producing or failing to produce evi-
48 dence in accordance with the order. Such evidence may be used in the
49 refusal, suspension or revocation of any license, permission or authority
50 conferred, or to be conferred, pursuant to Idaho Code.
51 (2) The attorney general or any prosecuting attorney or the designated
52 agent of either shall have the authority to issue subpoenas to an enrolled or
53 formerly enrolled provider of services pursuant to the medicaid program to
54 compel production of books, payrolls, accounts, papers, records, documents and
24
1 other items that may be relevant to an investigation of fraud or other crime
2 directly related to the use of medicaid program funds or services provided
3 through the medicaid program that are not already in the possession of the
4 director of the department of health and welfare or his designated agent. The
5 attorney general or any prosecuting attorney or the designated agent of either
6 may also compel testimony by the custodian of the items subpoenaed concerning
7 the production and authenticity of those items.
8 (a) A subpoena under this subsection (2) shall describe the items
9 required to be produced with particularity and prescribe a return date of
10 a reasonable period of time within which the items can be assembled and
11 made available to the attorney general or any prosecuting attorney or the
12 designated agent of either.
13 (b) At any time before the return date specified in the subpoena, the
14 enrolled or formerly enrolled provider who offers services pursuant to the
15 medicaid program may apply to a judge of the district court of the county
16 where such provider is in attendance, for an order modifying or quashing
17 the subpoena. A subpoena that requests items that are reasonably relevant
18 to an investigation of fraud or other crime directly related to the use of
19 medicaid program funds or services provided through the medicaid program,
20 shall not be modified or quashed. Probable cause for the issuance of an
21 investigatory subpoena under this subsection (2) shall not be required.
22 (3) Subpoenas issued pursuant to this section shall be served and witness
23 fees and mileage paid as allowed in civil cases in the district courts of this
24 state.
25 (4) Inspectors and iInvestigators employed by the Idaho state police
26 attorney general for the enforcement of this act investigation and prosecution
27 of providers of services pursuant to the medicaid program shall have all the
28 authority given by statute to peace officers of the state of Idaho, including,
29 but not limited to, authority to obtain, serve and execute warrants of arrest
30 and warrants of search and seizure.
31 SECTION 18. That Section 56-227D, Idaho Code, be, and the same is hereby
32 amended to read as follows:
33 56-227D. FEDERAL FOOD STAMPS -- UNAUTHORIZED USE -- EXCEPTION -- DEFINI-
34 TION. (a1) It is a misdemeanor for any person to buy, receive, sell, give
35 away, dispose of, exchange or barter any federal food stamps of a value of one
36 hundred fifty dollars ($150) or less, except for the eligible foods for which
37 they are issued.
38 (b2) It is a felony for any person to buy, receive, sell, give away, dis-
39 pose of, exchange or barter any federal food stamps of a value exceeding one
40 hundred fifty dollars ($150), except for the eligible foods for which they are
41 issued.
42 (c3) This section does not apply to any person buying, receiving, sell-
43 ing, giving away, disposing of, exchanging or bartering any federal food
44 stamps subsequent to the redemption of such stamps in the manner provided by
45 state or federal law.
46 (d4) As used in this section, federal food stamps refers to stamps issued
47 for food by the United States department of agriculture or its duly authorized
48 agent.
49 (5) This section shall be enforced by the director of the department of
50 health and welfare in cooperation with local law enforcement and prosecuting
51 agencies. Such enforcement shall not be the responsibility of the medicaid
52 fraud control unit as provided in section 56-226, Idaho Code.
25
1 SECTION 19. That Chapter 2, Title 56, Idaho Code, be, and the same is
2 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
3 ignated as Section 56-227E, Idaho Code, and to read as follows:
4 56-227E. OBSTRUCTION OF INVESTIGATION. (1) An obstruction of investiga-
5 tion consists of knowingly:
6 (a) Providing false information to, or knowingly withholding information
7 from, any person authorized to investigate a violation of this chapter or
8 to enforce the criminal or civil remedies of this chapter where that
9 information is material to the investigation or enforcement; or
10 (b) Altering any document or record required to be retained pursuant to
11 this chapter or any rule issued by the department of health and welfare,
12 when the alteration is intended to mislead an investigation and concerns
13 information material to that investigation.
14 (2) Whoever commits an obstruction of investigation shall be guilty of a
15 felony and shall be sentenced pursuant to the provisions of section 18-112,
16 Idaho Code.
17 SECTION 20. That Section 67-1401, Idaho Code, be, and the same is hereby
18 amended to read as follows:
19 67-1401. DUTIES OF ATTORNEY GENERAL. Except as otherwise provided in this
20 chapter, it is the duty of the attorney general:
21 (1.) To perform all legal services for the state and to represent the
22 state and all departments, agencies, offices, officers, boards, commissions,
23 institutions and other state entities, in all courts and before all adminis-
24 trative tribunals or bodies of any nature. Representation shall be provided to
25 those entities exempted pursuant to the provisions of section 67-1406, Idaho
26 Code. Whenever required to attend upon any court or administrative tribunal
27 the attorney general shall be allowed necessary and actual expenses, all
28 claims for which shall be audited by the state board of examiners.
29 (2.) To advise all departments, agencies, offices, officers, boards, com-
30 missions, institutions and other state entities in all matters involving ques-
31 tions of law.
32 (3.) After judgment in any of the causes referred to in the first subdi-
33 vision, to direct the issuing of such process as may be necessary to carry the
34 same into execution.
35 (4.) To account for and pay over to the proper officer all moneys
36 received which belong to the state.
37 (5.) To supervise nonprofit corporations, corporations, charitable or
38 benevolent societies, person or persons holding property subject to any public
39 or charitable trust and to enforce whenever necessary any noncompliance or
40 departure from the general purpose of such trust and, in order to accomplish
41 such purpose, said nonprofit corporations, corporations, charitable or benevo-
42 lent societies, person or persons holding property subject to any public or
43 charitable trust are subject at all times to examination by the attorney gen-
44 eral, on behalf of the state, to ascertain the condition of its affairs and to
45 what extent, if at all, said trustee or trustees may have failed to comply
46 with trusts said trustee or trustees have assumed or may have departed from
47 the general purpose for which it was formed. In case of any such failure or
48 departure, the attorney general shall institute, in the name of the state, any
49 proceeding necessary to enforce compliance with the terms of the trust or any
50 departure therefrom.
51 (6.) To give an opinion in writing, without fee, to the legislature or
52 either house thereof, or any senator or representative, and to the governor,
26
1 secretary of state, treasurer, state controller, and the superintendent of
2 public instruction, when requested, upon any question of law relating to their
3 respective offices. The attorney general shall keep a record of all written
4 opinions rendered by the office and such opinions shall be compiled annually
5 and made available for public inspection. All costs incurred in the prepara-
6 tion of said opinions shall be borne by the office of the attorney general. A
7 copy of the opinions shall be furnished to the supreme court and to the state
8 librarian.
9 (7.) When required by the public service, to repair to any county in the
10 state and assist the prosecuting attorney thereof in the discharge of duties.
11 (8.) To bid upon and purchase, when necessary, in the name of the state,
12 and under the direction of the state controller, any property offered for sale
13 under execution issued upon judgments in favor of or for the use of the state,
14 and to enter satisfaction in whole or in part of such judgments as the consid-
15 eration for such purchases.
16 (9.) Whenever the property of a judgment debtor in any judgment mentioned
17 in the preceding subdivision has been sold under a prior judgment, or is sub-
18 ject to any judgment, lien, or encumbrance, taking precedence of the judgment
19 in favor of the state, under the direction of the state controller, to redeem
20 such property from such prior judgment, lien, or encumbrance; and all sums of
21 money necessary for such redemption must, upon the order of the board of exam-
22 iners, be paid out of any money appropriated for such purposes.
23 (10.) When necessary for the collection or enforcement of any judgment
24 hereinbefore mentioned, to institute and prosecute, in behalf of the state,
25 such suits or other proceedings as may be necessary to set aside and annul all
26 conveyances fraudulently made by such judgment debtors; the cost necessary to
27 the prosecution must, when allowed by the board of examiners, be paid out of
28 any appropriations for the prosecution of delinquents.
29 (11.) To exercise all the common law power and authority usually apper-
30 taining to the office and to discharge the other duties prescribed by law.
31 (12.) To report to the governor, at the time required by this code, the
32 condition of the affairs of the attorney general's office and of the reports
33 received from prosecuting attorneys.
34 (13.) To appoint deputy attorneys general and special deputy attorneys
35 general and other necessary staff to assist in the performance of the duties
36 of the office. Such deputies and staff shall be nonclassified employees within
37 the meaning of section 67-5302, Idaho Code.
38 (14) To establish a medicaid fraud control unit pursuant to the provi-
39 sions of section 56-226, Idaho Code, and to exercise concurrent investigative
40 and prosecutorial authority and responsibility with county prosecutors to
41 prosecute persons for the violation of the criminal provisions of chapter 2,
42 title 56, Idaho Code, and for criminal offenses that are not defined in said
43 chapter 2, title 56, Idaho Code, but that involve or are directly related to
44 the use of medicaid program funds or services provided through the medicaid
45 program.
REPRINT REPRINT REPRINT REPRINT REPRINT REPRINT
STATEMENT OF PURPOSE
RS 16914
This legislation defines and provides for a Medicaid Fraud
Program in the Department of Health and Welfare that is outside
the scope and duties of the Medicaid Fraud Control Unit and
establishes in the Office of the Attorney General an independent
and certified Medicaid Fraud Control Unit as defined and required
in 42 U.S.C. Sections 1320(a)-7b(f)1 and 1396a(61). This
legislation also outlines the authority and duties of the
Medicaid Fraud Program and the Medicaid Fraud Control Unit. It
outlines the proper handling of Medicaid fraud referrals between
the Department of Health and Welfare and the Office of the
Attorney General. It provides to the Office of the Attorney
General and prosecuting attorneys authority to prosecute Medicaid
fraud. It requires the retention of Medicaid records.
Obstruction of investigations, incrimination, and criminal
penalties pertaining to Medicaid fraud are defined and set forth.
The adoption of procedures, collection of overpayments,
employment of necessary personnel, and rulemaking authority are
outlined.
FISCAL NOTE
The ongoing costs of creating a separate certified Medicaid Fraud
Unit within the Criminal Division of the Office of the Attorney
General is estimated to be $75,000 from the General Fund and
$675,000 from federal funds. The federal government will
reimburse the state 90% of the costs for the first three years,
and then in subsequent years will reimburse 75% of the expenses
of a certified unit. This unit will be comprised of two
attorneys, two investigators, two auditors, a paralegal, and a
legal secretary. This fiscal note does project any recoveries or
savings due to the deterrent impact of the unit. The state
portion of any recoveries shall be deposited into the General
Fund. The state typically receives 30% of any recovered funds.
Contact
Name: Rep. Mathews
Phone: 208 332-1000
Rep. Denney Rep. Block Rep. Hagedorn Sen. Cameron
Rep. Moyle Rep. McGeachin Rep. Bilbao Sen. Lodge
Rep. Bedke Rep. Loertscher Sen. McGee
Rep. Roberts Rep. Wood
Rep. Bell Rep. Henbest
STATEMENT OF PURPOSE/FISCAL NOTE H 166