Details On Medicaid Fraud Bill Flushed Out

A bill to root out Medicaid fraud has been flushed out with more details that includes establishing an office of Medicaid Inspector General and providing a testing of Medicaid claims.

SB 914 by Sen. David Sanders (R-Little Rock) and Rep. Bruce Westerman (R-Hot Springs) would create an office of Medicaid Inspector General in the Governor’s office.

The head of the office would be a gubernatorial appointment, confirmed by the state Senate, and would serve at the will of the Governor.

The bill stipulates that the director “shall have not less than ten (10) years of professional experience” in prosecution for fraud, fraud investigation, auditing, or “comparable alternate experience in health care, if the health care experience involves some consideration of fraud.”

The bill also allows the office to hire a staff of undetermined size. The group would investigate program fraud and abuse working in conjunction with the Attorney General’s Medicaid Fraud Control Unit as well as U.S. attorneys and prosecuting attorneys in Arkansas.

The office of Medicaid Inspector General would be built by consolidating the
staff and “other Medicaid fraud detection, prevention, and recovery functions from the relevant governmental entities into a single office.”

SB 914 also creates a new criminal offense of health care fraud and establishes five different degrees for prosecution.

It also provides that the office incorporate technology to test and strengthen the Medicaid payment system to detect fraud, improve accountability, and automate processes for the review of claims.

SB 914 also calls on an annual report on health insurance fraud to be submitted on or before March 1 by the Insurance Commissioner.

As Gov. Mike Beebe (D) and legislators attempt to hammer out a deal to use Medicaid expansion dollars to support subsidizing health insurance plans for lower-income Arkansans in forthcoming insurance exchanges, Republican lawmakers have pushed for more reforms to the current Medicaid program.