HB 353 -- MEDICAID FRAUD AND ABUSE (Schaaf)

COMMITTEE OF ORIGIN:  Special Committee on Healthcare Facilities

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

(1)  Expands the definition of "health care provider" to include
any employee, representative, or subcontractor of the state;

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

(3)  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 and upon conviction will be excluded from participation as
a provider for the program;

(4)  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;

(5)  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;

(6)  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;

(7)  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;

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

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

(10)  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; and

(11)  Creates a fund for the deposit of moneys recovered to be
used to increase Medicaid provider reimbursements until the
average Medicaid provider reimbursement equals the average
Medicare provider reimbursement.

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.

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