General Assembly Raised Bill No. 7105 seeks to improve the auditing process for healthcare facilities, particularly those involved in Medicaid programs, by introducing the concept of a "forensic audit." This term is defined as an examination of financial records to ensure compliance with applicable laws. The bill expands the scope of facilities subject to audits to include those licensed under sections 17b-340 and 17b-340d, and it requires the Commissioner of Social Services to provide written notification of audits at least thirty days in advance, except in cases involving health or safety concerns or evidence of vendor fraud. The legislation also outlines the procedures for conducting audits, including the production of preliminary and final reports, opportunities for facilities to present evidence, and the process for requesting a rehearing if a facility disputes a final report.

Additionally, the bill establishes penalties for submitting false information, which may result in payment suspensions and criminal charges. It grants the commissioner the authority to administer oaths and subpoena witnesses during inquiries. The bill mandates free training for facilities on preparing cost reports to reduce clerical errors and requires the commissioner to publish information about the auditing process on the department's website. It also sets conditions for conducting forensic audits, including the need for facilities to address financial concerns beforehand and to cooperate with audit requests within ten business days, with potential civil monetary penalties for non-compliance. Furthermore, facilities may be liable for the costs of forensic audits if significant financial issues are found, capped at $100,000, and the Department of Social Services can recover audit-related costs through recoupment from Medicaid payments.

Statutes affected:
Raised Bill: