senate Bill S2617A

Relates to creating incentives for counties to investigate and prosecute medicaid fraud

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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  • 23 / Jan / 2013
    • REFERRED TO SOCIAL SERVICES
  • 25 / Apr / 2013
    • AMEND AND RECOMMIT TO SOCIAL SERVICES
  • 25 / Apr / 2013
    • PRINT NUMBER 2617A
  • 29 / May / 2013
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 29 / May / 2013
    • ORDERED TO THIRD READING CAL.808
  • 30 / May / 2013
    • PASSED SENATE
  • 30 / May / 2013
    • DELIVERED TO ASSEMBLY
  • 30 / May / 2013
    • REFERRED TO HEALTH
  • 08 / Jan / 2014
    • DIED IN ASSEMBLY
  • 08 / Jan / 2014
    • RETURNED TO SENATE
  • 08 / Jan / 2014
    • REFERRED TO SOCIAL SERVICES
  • 13 / May / 2014
    • REPORTED AND COMMITTED TO FINANCE
  • 28 / May / 2014
    • 1ST REPORT CAL.935
  • 29 / May / 2014
    • 2ND REPORT CAL.
  • 02 / Jun / 2014
    • ADVANCED TO THIRD READING
  • 12 / Jun / 2014
    • PASSED SENATE
  • 12 / Jun / 2014
    • DELIVERED TO ASSEMBLY
  • 12 / Jun / 2014
    • REFERRED TO HEALTH

Summary

Creates incentives for counties to investigate and prosecute medicaid fraud.

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Bill Details

See Assembly Version of this Bill:
A5042A
Versions:
S2617
S2617A
Legislative Cycle:
2013-2014
Current Committee:
Assembly Health
Law Section:
Social Services Law
Laws Affected:
Add Art 5-A §370-bb, amd §145-b, Soc Serv L
Versions Introduced in 2011-2012 Legislative Cycle:
S6881, A9494

Sponsor Memo

BILL NUMBER:S2617A

TITLE OF BILL: An act to amend the social services law, in relation
to creating incentives for counties to investigate and prosecute
medicaid fraud

PURPOSE: The purpose of this bill is to provide financial incentives
to the City of New York and the counties to identify and prosecute
Medicaid fraud, thereby helping eliminate fraud, waste and abuse.

SUMMARY OF PROVISIONS: The social services law is amended by adding a
new article 5-A and amending subdivision 2 of section 145-b to enable
the City of New York and the counties to keep 100% of the local share
of any successful Medicaid fraud prosecution or settlement, or 10% of
the total recovery, whichever is greater.

JUSTIFICATION: It is essential to minimize any waste, fraud or abuse
in the Medicaid system by encouraging and rewarding successful efforts
by the City of New York and the counties to prosecute Medicaid fraud.

The current law limits the amounts that local governments can receive
based on successful Medicaid fraud prosecution. This bill would ensure
that local governments would receive 100% of the local share of such
Medicaid payments, thereby reimbursing the local governments in full
for the original overpayment. Since the local share on some programs
may be very small, the local governments would be guaranteed at least
10% of any recovery, including settlement. The State would receive the
balance of recoveries.

By encouraging more Medicaid fraud prosecutions, the total costs of
the system will be reduced, to the benefit of both the State and local
governments. The State, of course, would be the biggest beneficiary of
the reduction in the amount of fraud and abuse because it pays a
substantially higher percentage of Medicaid costs than the local
governments.

This legislation is particularly important because the existing
Medicaid payment cap that applies to local governments inadvertently
reduced the financial incentive for local governments to root out
fraud, waste and abuse. Under the cap legislation, the cost to local
governments is automatically determined by the amount specified by the
cap rather than being based on actual costs. This bill would restore
the financial incentive to local governments by enabling them to enjoy
100% of the local share of any savings resulting from successful
Medicaid fraud prosecutions and settlements.

LEGISLATIVE HISTORY: 2012: S 6881/A.9494 Passed Senate

FISCAL IMPLICATIONS: This bill allows the city of New York and the
counties to recoup 100% of the local share upon the successful
prosecution or settlement of Medicaid fraud, or 10% of the total
recovery, whichever is greater.

EFFECTIVE DATE: This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2617--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 23, 2013
                               ___________

Introduced  by  Sens. YOUNG, GALLIVAN -- read twice and ordered printed,
  and when printed to be committed to the Committee on  Social  Services
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

AN ACT to amend the social services law, in relation to creating  incen-
  tives for counties to investigate and prosecute medicaid fraud

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The social services law is amended by adding a new  article
5-A to read as follows:
                                ARTICLE 5-A
                      MEDICAID FRAUD REIMBURSEMENT
SECTION  370-BB.  DISPOSITION  OF  MONEYS  RECEIVED AS THE RESULT OF THE
                  PROSECUTION OF MEDICAID FRAUD.
  S 370-BB. DISPOSITION OF MONEYS RECEIVED AS THE RESULT OF  THE  PROSE-
CUTION OF MEDICAID FRAUD. 1. FOR THE PURPOSES OF THIS SECTION, "MEDICAID
FRAUD"  SHALL  MEAN  THE  KNOWING COMMISSION OF ANY CRIME WITH INTENT TO
ILLEGALLY RECEIVE BENEFITS, OR REIMBURSEMENT FROM THE MEDICAL ASSISTANCE
FOR NEEDY PERSONS PROGRAM ESTABLISHED AND ADMINISTERED PURSUANT TO  THIS
CHAPTER, THE PUBLIC HEALTH LAW AND FEDERAL LAW.
  2.  SHOULD  ANY  COUNTY OR THE CITY OF NEW YORK SUCCESSFULLY PROSECUTE
ANY CASE FOR MEDICAID FRAUD AND A  COURT  AWARDS  RESTITUTION  OR  CIVIL
FORFEITURE,  THE  FOLLOWING  PORTION  OF  THE  NON-FEDERAL  SHARE OF THE
PROCEEDS OF SUCH RESTITUTION OR CIVIL FORFEITURE SHALL BE  ALLOCATED  AS
FOLLOWS:
  (I)  THE  COUNTY  OR  THE  CITY  OF NEW YORK SHALL RECEIVE ONE HUNDRED
PERCENT OF THE LOCAL SHARE OF SUCH FUNDS, IN EFFECT IMMEDIATELY PRIOR TO
SUCH DATE AS CERTIFIED BY THE DIVISION OF BUDGET OR TEN PERCENT  OF  THE
TOTAL RECOVERY WHICHEVER NUMBER IS GREATER;
  (II) THE REMAINDER THEREOF SHALL BE DEPOSITED INTO THE GENERAL FUND OF
THE STATE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07129-02-3

S. 2617--A                          2

  3.  NOTHING IN THIS ARTICLE SHALL IMPAIR ANY COUNTY OR THE CITY OF NEW
YORK'S ABILITY TO SEEK DAMAGES UNDER SECTION ONE HUNDRED FORTY-FIVE-B OF
THIS CHAPTER.
  S  2.  Paragraph  (a)  of subdivision 2 of section 145-b of the social
services law, as amended by chapter 109 of the laws of 2007, is  amended
to read as follows:
  (a)  For  civil damages collected by a local social services district,
relating to the medical assistance program, pursuant to  a  judgment  OR
SETTLEMENT  under  this  subdivision,  such amounts shall be apportioned
between the local social  services  district  and  the  state.  [If  the
violation  occurred:  (i) prior to January first, two thousand six, the]
THE amount apportioned to the local social services  district  shall  be
ONE  HUNDRED  PERCENT  OF the local share [percentage] OF SUCH FUNDS, in
effect immediately prior to such date as certified by  the  division  of
budget[,  or  (ii)  after  January  first,  two thousand six, the amount
apportioned to the local social services district shall be  based  on  a
reimbursement  schedule,  created  by  the  office of Medicaid inspector
general, in effect at the time the violation occurred; provided that, if
there is no schedule in effect at the time the violation  occurred,  the
schedule to be used shall be the first schedule adopted pursuant to this
subdivision.  Such  schedule  shall provide for reimbursement to a local
social services district in an amount between ten and fifteen percent of
the gross amount collected. Such schedule shall be set on  a  county  by
county  basis  and  shall be periodically reviewed and updated as neces-
sary; provided, however, that any such updated  schedule  shall  not  be
less  than  ten  percent  nor  greater than fifteen percent of the gross
amount collected] OR TEN PERCENT OF THE TOTAL RECOVERY WHICHEVER  NUMBER
IS GREATER; and
  S 3. This act shall take effect immediately.

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