This bill seeks to enhance the integrity of Minnesota's medical assistance program by implementing several key modifications to existing program integrity requirements. It establishes a Medical Assistance Program Integrity Advisory Board, which is tasked with overseeing program integrity efforts and providing recommendations on provider enrollment standards and modernizing program integrity infrastructure. The commissioner of human services is also directed to conduct audits, submit reports, and appropriate necessary funds for these activities. Notably, the bill introduces new provisions that impose fines for incomplete documentation, mandates suspension or termination of program participation following exclusion from Medicare, and allows for the withholding or reduction of payments without prior notice under certain conditions.

Additionally, the bill outlines the commissioner’s authority to withhold or reduce payments to individuals or entities convicted of fraud-related crimes or under investigation for credible allegations of fraud. It specifies the criteria for determining credible allegations and the notification process for affected parties. The bill also establishes a forfeiture of withheld payments upon criminal conviction related to health services under medical assistance. By emphasizing a proportional approach to program integrity interventions and appropriating funds to enhance the Medicaid Fraud Control Unit's capacity, the bill aims to strengthen oversight and accountability within the medical assistance program while ensuring due process for providers.

Statutes affected:
Introduction: 245.095, 256B.064