What's happening
This bill requires New York State to fully reimburse counties for purchasing and using data mining software to investigate Medicaid fraud, waste, and abuse.
Why it matters
Shifts financial responsibility from counties to the state. for investing in advanced technology to detect Medicaid fraud, waste, and abuse, potentially freeing up local resources for other priorities or services.
Encourages broader adoption of data mining tools. by local social services districts, which could lead to more comprehensive and proactive detection of improper payments and activity in the Medicaid system.
Standardizes support for anti-fraud efforts. by requiring state reimbursement regardless of whether the county already owns or plans to buy the software, ensuring both early adopters and newcomers are treated equally.
Allows for future oversight and adaptability. by granting the Commissioner of Health authority to set rules and regulations, which could help address evolving technology and fraud tactics over time.
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Who cares
Headline styles
Pay Counties for Fraud Software
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Pay Counties for Fraud Software
In Assembly Committee · Social Services · Sponsor Philip Palmesano
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
949
2019-2020 Regular Sessions
IN SENATE
January 9, 2019
Introduced by Sen. O'MARA -- 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 Assembly, 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 software 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 applicable, 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.
§ 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05766-01-9
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
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 coun- ties 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 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.
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 Medi- caid 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 Medi- caid 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 prose- cute 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
2018-S.2821 2016-S.1444 2014-S.3284
Fiscal implications
Undetermined at this time. However, any cost would conceivably be accom- plished through FWA investigation, prosecution and deterrence.
Effective date
This bill shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.