senate Bill S3284

Reimburses counties who have purchased or will purchase Medicaid fraud detection software

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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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actions

  • 31 / Jan / 2013
    • REFERRED TO HEALTH
  • 08 / Jan / 2014
    • REFERRED TO HEALTH

Summary

Reimburses counties who have purchased or will purchase Medicaid fraud detection software.

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Bill Details

Versions:
S3284
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd ยง368-a, Soc Serv L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S4614
2009-2010: A2053
2007-2008: A5333

Sponsor Memo

BILL NUMBER:S3284

TITLE OF BILL: An act to amend the social services law, in relation to
the state reimbursement of county payments for medical assistance fraud,
waste and abuse detection software

PURPOSE: To provide fiscal relief to counties in combating Medical
fraud, waste and abuse through the use of data mining software.

SUMMARY OF PROVISIONS: Amends the social services law by adding a new
paragraph aa to section 368-a of the social services law to require the
State to reimburse counties if such county has previously purchased or
intends to purchase data mining software that detects inaccuracies in
the Medicaid system. Further defines "data mining software" as a data-
base application that utilizes advanced data searching capabilities and
statistical analyses to discover patterns and correlations in the use
and abuse of medical assistance practices.

JUSTIFICATION: New York State's Medicaid program is the largest and
most costly in the nation. Although New York has seven percent of the
U.S. population, Medicaid cost the State approximately $46.5 billion in
2007 - 33 percent more than California, which maintains the nation's
second largest Medicaid system. Between DOH and the State's Medicaid
Fraud Control Unit (MFCU), New York spends more than $130 million to
combat fraud. Further, statistics indicate that fraud equals about ten
percent of total Medicaid dollars spent each year in New York State.

Medicaid costs are the largest part of county budgets and fraud, waste
and abuse (FWA) consume a good portion of these budgets. Providing fund-
ing to counties to do their own FWA investigations would free up
resources at the State level for more complicated cases. Counties can
immediately determine where there may be a problem by drilling through
reimbursement data, thus giving them better control of their Medicaid
dollars and become more accountable to the taxpayer.

Additionally, smaller counties have cited numerous concerns over paying
for this software themselves, although many of them are supportive of
the concept. Counties such as Franklin, Clinton and Essex already do not
have enough staff assigned to the task of investigating FWA, and there-
fore cannot pay for software and hire additional staff to utilize this
software for these investigations. Furthermore, they have indicated
that if the State is dedicated to having the counties investigate and
prosecute FWA then they should also dedicate the funds to do so.

Combating fraud ,waste and abuse is the first step in fixing a broken
system. The Medicaid program itself was established with honest
intentions and it is our duty to preserve it so that those individuals
who need Medicaid services the most receive them, and those who are
utilizing Medicaid fraudulently are prosecuted accordingly.

LEGISLATIVE HISTORY: 2009: A.2053 2008: A.5333

FISCAL IMPLICATIONS: Undetermined at this time. However, any cost would
conceivably be accomplished through FWA investigation, prosecution and
deterrence.

EFFECTIVE DATE: This bill shall take effect immediately.

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

                                  3284

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 31, 2013
                               ___________

Introduced by Sens. O'MARA, DeFRANCISCO, MAZIARZ, RANZENHOFER, SEWARD --
  read  twice  and  ordered printed, and when printed to be committed to
  the Committee on Health

AN ACT to amend the social  services  law,  in  relation  to  the  state
  reimbursement  of  county payments for medical assistance fraud, waste
  and abuse detection software

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

  Section  1.  Subdivision 1 of section 368-a of the social services law
is amended by adding a new paragraph (aa) to read as follows:
  (AA) (I) NOTWITHSTANDING ANY OTHER PROVISION OF LAW, THE  FULL  AMOUNT
EXPENDED  BY  THE  LOCAL SOCIAL SERVICES DISTRICT FOR MEDICAL ASSISTANCE
FRAUD, WASTE AND ABUSE INVESTIGATIONS VIA THE USE OF DATA  MINING  SOFT-
WARE  SHALL  BE  REIMBURSED  BY  THE  STATE IF THE COUNTY HAS PREVIOUSLY
PURCHASED OR INTENDS TO PURCHASE SUCH SOFTWARE. FOR THE PURPOSES OF THIS
PARAGRAPH, "DATA MINING SOFTWARE" SHALL MEAN A DATABASE APPLICATION THAT
UTILIZES ADVANCED DATA SEARCHING CAPABILITIES AND  STATISTICAL  ANALYSES
TO  DISCOVER  PATTERNS  AND CORRELATIONS IN THE USE AND ABUSE OF MEDICAL
ASSISTANCE PRACTICES. ANY COUNTY  THAT  HAS  PREVIOUSLY  PURCHASED  SUCH
SOFTWARE  MUST  SUPPLY  ADEQUATE  DOCUMENTATION, INCLUDING ANY RECEIPTS,
THAT DETAILS SUCH PURCHASE. THE STATE SHALL DISBURSE GRANTS, WHEN APPLI-
CABLE, FROM THE GENERAL FUND FOR THIS PURPOSE.
  (II) THE COMMISSIONER OF HEALTH MAY DEVELOP RULES AND  REGULATIONS  AS
NECESSARY TO CARRY OUT THE PROVISIONS OF THIS PARAGRAPH.
  S 2. This act shall take effect immediately.



 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08532-01-3

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