HCS SS SCS SB 1210, 1244 & 844 -- MISSOURI MEDICAID FRAUD

SPONSOR:  Koster (Pratt)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Healthcare Facilities by a vote of 10 to 0.

This substitute allows individuals to sue for Medicaid fraud and
changes the provisions regarding the reporting and investigation
of the fraud.  In its main provisions, the substitute:

(1)  Specifies that any person who willfully prevents, obstructs,
misleads, delays, or attempts to prevent, obstruct, mislead, or
delay the communication of information relating to fraud will be
guilty of a class D felony;

(2)  Specifies that any person discovering a violation and
reporting the information voluntarily before it becomes public or
known to the Attorney General will not be criminally prosecuted;

(3)  Allows any person who is the original source of the
information used by the Attorney General to receive 10% of any
recovery unless that individual planned, initiated, or
participated in the conduct;

(4)  Prohibits an employer from discharging, demoting,
suspending, threatening, harassing, or otherwise discriminating
against an employee because he or she initiates, assists, or
participates in a proceeding or court action.  An employer
violating this section must reinstate the employee without loss
of seniority, two times the amount of lost back pay, and
interest.  This will not apply to an employee who has brought a
frivolous claim; planned, initiated, or assisted in the wrong
doing; or has been convicted of Medicaid fraud;

(5)  Requires the Attorney General to report by January 1, 2007,
and annually thereafter, to the General Assembly and the Governor
on the number of investigations conducted; number of referrals;
total amount of overpayments, fines, and restitutions; moneys
recovered; and number of arrests, indictments, and convictions;

(6)  Requires the Department of Social Services to report by
January 1, 2007, and annually thereafter, to the General Assembly
and the Governor on the number of Medicaid provider and recipient
investigations; long-term care facilities reviewed; referrals
sent by the Office of the Attorney General; total amount of
overpayments, fines, and restitutions; moneys recovered; and
number of administrative sanctions against Medicaid providers;

(7)  Prohibits any person from knowingly destroying or concealing
medical records with the intent to defraud the medical assistance
programs.  A violation of this provision will be guilty of a
class A misdemeanor;

(8)  Specifies that a person submitting a claim or upon receipt
for medical assistance must not destroy or conceal any records
for five years after payment was received or submitted if payment
was not received;

(9)  Specifies that any person who intentionally files a false
report or claim alleging Medicaid fraud will be guilty of a class
A misdemeanor.  Any subsequent violations or any person receiving
compensation in exchange for knowingly failing to report fraud
will be guilty of a class D felony; and

(10)  Creates, beginning September 1, 2006, an advisory working
group to study whether an Office of Inspector General should be
established for the oversight, auditing, investigation, and
performance review of state medical assistance programs to deter
and identify fraud, abuse, and illegal acts.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of $75,519
to $175,519 in FY 2007, $88,547 to $188,547 in FY 2008, and
$90,762 to $190,762 in FY 2009.  No impact on Other State Funds
in FY 2007, FY 2008, and FY 2009.

PROPONENTS:  Supporters say the bill is necessary because up to
10% of the state's Medicaid budget goes to paying fraudulent
claims.  Under the federal Deficit Reduction Act of 2005, if a
state has a qualifying false claims act, it will be eligible for
a 10% increase when Medicaid false claims act cases are decided.

Testifying for the bill were Senator Koster; Representative
Pratt; Division of Medical Services, Department of Social
Services; and Missouri Budget Project.

OPPONENTS:  Those who oppose the bill say that it will cause
physicians to stop seeing Medicaid patients because a minor
mistake by the healthcare provider could result in a felony
prosecution.

Testifying against the bill were Missouri State Medical
Association; Missouri Podiatric Medical Association; Missouri
Association of Osteopathic Physicians and Surgeons; Eastern
Missouri Psychiatric Society; Missouri Health Care Association;
Missouri Retailers Association; Missouri Pharmacy Association;
and BJC HealthCare.

Dominic Lackey, Legislative Analyst

Missouri House of Representatives
93rd General Assembly, 2nd Regular Session
Last Updated November 29, 2006 at 9:47 am