HCS/SS/SCS/SBs 1210, 1244 & 844 - This act provides that a person commits a "knowing" violation of sections prohibiting Medicaid fraud if he or she has actual knowledge of the information, acts in deliberate ignorance of the truth or falsity of the information, or acts in reckless disregard of the truth or falsity of the information, but provides that use of the terms "knowing" or "knowingly" shall be construed to include the term "intentionally". Current law provides that any person committing such a violation shall be guilty of a Class D felony upon a first conviction, and shall be guilty of a Class C felony upon subsequent convictions; this act provides that such person shall be guilty of a Class C felony upon a first conviction, and shall be guilty of a Class B felony upon subsequent convictions. Any natural person who has been convicted of such violations shall be referred to the Office of the Inspector General within the United States Department of Health and Human Services. Any natural person who willfully prevents, obstructs, misleads, delays, or attempts to do any of the aforementioned with regard to communication of information relating to a violation of Medicaid fraud shall be guilty of a Class D felony. Any person who discovers a violation by himself or herself or such person's organization and who reports such information voluntarily before such information is public or known to the attorney general shall not be prosecuted for a criminal violation.
This act provides that any person who is the original source of information used by the Attorney General to bring an action for Medicaid fraud shall receive ten percent of any recovery by the Attorney General. If the court finds that the person who was the original source of the information used by the Attorney General to bring an action for Medicaid fraud planned, initiated, or participated in the conduct upon which the action is brought, such person shall not be entitled to any percentage of the recovery. Also, any person who is the original source of information about the willful violation by any person of any of the provisions of Chapter 36, RSMo, shall receive ten percent of the amount of compensation that would have been paid the employee forfeiting his or her position under Section 36.460, if the employee was found to have acted fraudulently in connection with the state medical assistance program.
The act also contains "whistle-blower" protections, providing that a person who is discharged, demoted, suspended, threatened, harassed, or in any way discriminated against in terms of employment due to a lawful act taken by the person in furtherance of an action for Medicaid fraud shall be entitled to reinstatement with the same seniority status, not less than two times the amount of back pay, and interest on the back pay. However, such protections shall not apply if the court finds that the employee brought a frivolous or clearly vexatious claim, planned, initiated, or participated in the conduct upon which the action is brought, or is convicted of criminal conduct arising from Medicaid fraud violations.
The act provides that the Attorney General's office and the Department of Social Services shall make a detailed report to the General Assembly and the Governor regarding implementation and administration of the provisions of this act, as provided therein. Additionally, a financial audit of the medicaid fraud unit within the Attorney General's office and of the program integrity unit of the Department of Social Services shall be annually conducted by the state auditor, to quantitatively determine the amount of money invested in such units and the amount of money actually recovered by them.
The act also provides that no person knowingly with the intend to defraud the medical assistance program shall destroy or conceal records that are necessary to fully disclose the nature of health care for which a claim was submitted or payment was received under a medical assistance program. All Medicaid health care providers shall maintain such records for at least five years after the date payment was received or for at least five years after the date on which the claim was submitted, if payment was not received. No person shall conceal or destroy such records before five years time, or he or she shall be guilty of a Class A misdemeanor.
The act provides that any person who intentionally files a false report or claim alleging a Medicaid fraud violation is guilty of a Class A misdemeanor, and shall be guilty of a Class D felony upon second or subsequent convictions. In addition, it shall be a Class D felony for any person to receive any compensation in exchange for knowingly failing to report any Medicaid fraud violations.
This act also creates an advisory working group to study and determine whether an office of inspector general shall be established. Such office would be responsible for oversight, auditing, investigation, and performance review to provide increased accountability, integrity, and oversight of state medical assistance programs. The commission will consist of ten members, five from the House and five from the Senate. Additionally, the directors of the Departments of Social Services, Health and Senior Services, and Mental Health shall serve as ex-officio members of the advisory working group.