HB 353 -- MEDICAID FRAUD AND ABUSE

SPONSOR:  Schaaf

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Healthcare Facilities by a vote of 8 to 0.

This bill changes the laws regarding fraud and abuse in the
Missouri Medicaid Program.  The bill:

(1)  Specifies that the terms "knowing" and "knowingly" mean
intentionally;

(2)  Changes the penalty for making a false statement to a class
C felony for a first conviction and a class B felony for
subsequent convictions.  A person who attempts to or willfully
prevents, obstructs, misleads, or delays the communication of
information relating to a violation will be guilty of a class D
felony;

(3)  Specifies that any person who is the original source of
information regarding a violation will be compensated unless he
or she participated in the fraud or abuse;

(4)  Prevents an employer from discriminating against an employee
for participating in a court action relating to a violation
unless the employee filed a frivolous claim, participated in the
violation, or is convicted of criminal conduct related to the
violation;

(5)  Requires the Office of the Attorney General and the
Department of Social Services to report information regarding
violations to the Governor and General Assembly by January 1,
2008, and annually thereafter;

(6)  Requires the State Auditor to complete a financial audit of
the Medicaid fraud unit within the Office of the Attorney General
and the program integrity unit within the Department of Social
Services;

(7)  Establishes a penalty for destroying or concealing records
of claims submitted or payments received;

(8)  Establishes a penalty for filing false reports or claims of
alleged violations and receiving compensation for failure to
report violations; and

(9)  Creates an advisory working group, beginning September 1,
2007, to determine the need for an Office of Inspector General to
oversee the state's medical assistance programs.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of $52,710
to $152,710 in FY 2008, $58,099 to $158,099 in FY 2009, and
$59,841 to $159,841 in FY 2010.  No impact on Other State Funds
in FY 2008, FY 2009, and FY 2010.

PROPONENTS:  Supporters say that the bill addresses the concerns
of health care providers regarding Medicaid fraud.  Under the
provisions of the bill, providers will be less likely to reject
Medicaid patients as compared to previous bills addressing
Medicaid fraud.  The bill offers a financial incentive for
individuals to report fraud, encourages providers to
self-disclose information, protects "whistle blowers," and deters
frivolous claims.

Testifying for the bill were Representative Schaaf; Missouri
Dental Association; Missouri Assisted Living Association;
Missouri Association of Homes for the Aging; Missouri Association
of Osteopathic Physicians and Surgeons; Missouri Pharmacy
Association; Missouri Chamber of Commerce and Industry; Missouri
Hospital Association; Missouri Academy of Family Physicians;
Eastern Missouri Psychiatric Society; Missouri Health Care
Association; and Missouri State Medical Association.

OPPONENTS:  There was no opposition voiced to the committee.

Missouri House of Representatives
94th General Assembly, 1st Regular Session
Last Updated July 25, 2007 at 11:18 am