The bill amends the Medical Assistance Programs Integrity Law to enhance the prosecution and investigation of fraud in medical assistance programs, particularly Medicaid. It redefines "knowing" or "knowingly" to eliminate the need for proof of specific intent to defraud and clarifies the definition of "medical assistance programs." New terms, such as "managed care organization," are introduced, and the bill establishes procedures for qui tam actions, allowing private individuals to sue on behalf of the state for violations. It emphasizes the responsibilities of healthcare providers and managed care organizations in relation to fraudulent claims, explicitly stating that no person shall knowingly submit false claims or misrepresent information to obtain payments.

Additionally, the bill modifies the procedures for filing qui tam actions, requiring complaints to be delivered to the state and maintaining confidentiality until judicial service is made. It introduces specific language for complaint titles and allows the state to intervene while controlling the proceedings. If the state opts not to proceed, the qui tam plaintiff can continue the action, with obligations to serve pleadings on the state. The bill also clarifies the recovery awarded to qui tam plaintiffs and includes provisions for awarding costs and fees to defendants if claims are deemed frivolous. Several existing provisions related to qui tam actions are repealed to streamline the legal framework.

Statutes affected:
HB560 Original: 46:3, 46:5(B), 46:1(A), 46:6(D)(3), 46:7(3), 46:2(A)(1), 46:4(A)(1), 46:3(7), 46:6(A)(2), 46:8(D)(2), 46:1(F), 46:2(F)
HB560 Engrossed: 46:3, 46:5(B), 46:1(A), 46:6(D)(3), 46:7(3), 46:2(A)(1), 46:4(A)(1), 46:3(7), 46:6(A)(2), 46:8(D)(2), 46:1(F), 46:2(F)
HB560 Reengrossed: 46:3, 46:5(B), 46:1(A), 46:6(D)(3), 46:7(3), 46:2(A)(1), 46:4(A)(1), 46:3(7), 46:6(A)(2), 46:8(D)(2), 46:1(F), 46:2(F)
HB560 Enrolled: 46:3, 46:5(B), 46:1(A), 46:6(D)(3), 46:7(3), 46:2(A)(1), 46:4(A)(1), 46:3(7), 46:6(A)(2), 46:8(D)(2), 46:1(F), 46:2(F)
HB560 Act : 46:3, 46:5(B), 46:1(A), 46:6(D)(3), 46:7(3), 46:2(A)(1), 46:4(A)(1), 46:3(7), 46:6(A)(2), 46:8(D)(2), 46:1(F), 46:2(F)