110 HR 6769 IH: Medicaid Fraud Recovery Act of U.S. House of Representatives 2008-07-31 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 2d Session H. R. 6769 IN THE HOUSE OF REPRESENTATIVES July 31, 2008 Mr. Weiner introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to strengthen State and local government efforts to investigate and prosecute fraud and abuse in the Medicaid Program.

1.

Short title

This Act may be cited as the Medicaid Fraud Recovery Act of 2008.

2.

Promoting Medicaid fraud investigations and prosecutions by local governments

(a)

In general

Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection: (aa)

Use and funding of local fraud units

(1)

In general

Nothing in this title shall be construed as preventing a county or other local government from establishing a local fraud investigative unit to investigate and prosecute provider and recipient fraud under this title within the jurisdiction of such local government. (2)

State recognition and funding of local units

In the case of the establishment by a local government of a local fraud investigative unit in a State under paragraph (1), the State shall provide in its State plan under this title the following: (A)

Recognition of unit

The plan shall recognize such a unit and permit its operations in accordance with this subsection and may not establish internal procedures that prevent such a unit from being recognized or functioning. (B)

Data sharing required

The Department of Health of the State and any administrative unit responsible for claims administration under this title in the State shall make available to such unit all data relating to this title in the area of such unit. (C)

Pass-through payment of FFP

The State shall provide for payment, on a pass-through basis, to the local government of the Federal financial participation received by the State under section 1903(a) which is attributable to expenses of such unit. (D)

Repayment of local share in case of recoupment

In the case of a State in which local governments are responsible for paying a portion of medical assistance expenses, if there is a recoupment of funds under the State plan and— (i)the recoupment was a result of activities of such a unit of local government, the State shall provide for payment to the local government of its original share of the expenses for which the recoupment is made; or (ii)the recoupment was not the result of activities of such a local government unit, the State shall provide for the payment described in clause (i) to the local government unless otherwise provided under an agreement between the State and local government involved. (E)

Payment of bounty in case of local prosecution

If funds under the plan are recouped and an investigation by such local unit led the recoupment of funds, the State shall, from its share of such recouped funds, provide for payment to the local government of a bounty equal to 10 percent of such recouped share. (3)

Explanation for failures to prosecute

If a State refuses to prosecute a case which has been referred to it by a local fraud investigative unit described in paragraph (1), the State must provide to the unit a statement that— (A)explains the reasons for such refusal; and (B)identifies which entity is more appropriate to handle the prosecution or resolution of the case and the reasons for selecting such entity. (4)

Requirement for semi-annual reports

As a condition for the provision of payments to a State (or to a locality under paragraph (2)(C)) under subsection (a)(6), the State or locality shall submit semiannual reports to the Secretary. Such reports shall contain such information on investigations and prosecutions of fraud under this title as the Secretary may specify. (5)

Method for determination of referrals

For purposes of this subsection, the State shall establish a method for determining whether a recoupment of funds was a result of activities of a unit of local government and for identifying cases in which a local fraud investigative unit has referred a case for prosecution. .

3.

Enhanced Medicaid funding for anti-fraud activities

(a)

In general

Section 1903(a)(6)(B) of the Social Security Act (42 U.S.C. 1396b(a)(6)(B)) is amended by inserting before the semicolon at the end the following: plus, not subject to the limitations of subsection (b)(3), 662/3 percent of such additional sums expended in the quarter for fraud investigative activities, whether conducted by such unit or by local fraud investigative units described in subsection (aa)(1). (b)

Effective date

The amendment made by paragraph (1) shall apply to expenditures occurring on or after October 1, 2008.