House Bill No. by Representative Egan aims to amend the Medical Assistance Programs Integrity Act to enhance the prosecution and investigation of fraud related to medical assistance programs. The bill clarifies definitions, such as specifying that "knowing" does not require proof of specific intent to defraud, and introduces new terms like "managed care organization." It establishes procedures for qui tam actions, allowing private individuals to file civil actions on behalf of the state for violations of the act. The bill also modifies existing provisions regarding settlements, injunctive relief, and civil actions, ensuring the rights of qui tam plaintiffs are preserved while emphasizing the responsibilities of healthcare providers and managed care organizations to avoid fraudulent claims.

Additionally, the bill introduces new provisions that expand the definitions of fraudulent actions against Medicaid, including prohibiting false statements related to healthcare services. It streamlines the legal framework surrounding Medicaid fraud and qui tam actions by repealing outdated provisions and clarifying the roles of the state in legal actions. Key changes include stipulating that qui tam actions can only be dismissed with written consent from the court and the attorney general, and that the caption for such actions will reflect the state's involvement. The bill also allows the court to impose limitations on a qui tam plaintiff's participation if necessary, while modifying the process for settlements to include in-camera hearings when warranted.

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)