BILL NUMBER: S10680
SPONSOR: MURRAY
 
TITLE OF BILL:
An act to amend the public health law, in relation to the handling of
tips received through the office of the Medicaid inspector general's
Medicaid fraud hotline
 
SUMMARY OF PROVISIONS:
Section 1 amends subdivisions 4, 5 and 7 of section 32 of the Public
Health Law to designate the Office of the Medicaid Inspector General's
Medicaid fraud hotline as the official Medicaid fraud hotline of the
State of New York and establish procedures for the handling of tips
received through the hotline.
The bill requires the Medicaid Inspector General to determine whether a
tip constitutes a credible allegation and, when such a determination is
made, to share all information contained in the allegation with the
Medicaid Fraud Control Unit of the Office of the Attorney General and
any prosecutor of competent jurisdiction. Within thirty days, a determi-
nation must be made as to whether the allegation will be investigated
and, if so, which jurisdiction will lead the investigation. The Medicaid
Inspector General must also be notified of the outcome upon completion
of the investigation.
The bill further requires the Medicaid Inspector General to compile an
annual report detailing the number of hotline tips received, the number
investigated, who conducted each investigation, and the outcomes of
those investigations. The report must be provided to the Governor,
legislative leaders and the Attorney General.
Section 2 provides the effective date.
 
JUSTIFICATION:
Medicaid is one of New York State's largest and most important public
programs. Fraud and abuse within the Medicaid program not only waste
taxpayer dollars, but also divert resources from the millions of New
Yorkers who rely upon the program for access to health care. Reports of
suspected fraud therefore must be handled in a manner that ensures cred-
ible allegations receive appropriate review and are promptly brought to
the attention of officials with the authority to investigate and prose-
cute wrongdoing.
The Office of the Medicaid Inspector General maintains a hotline through
which suspected Medicaid fraud and abuse may be reported. Unfortunate-
ly, the limited resources of the Attorney General and the Office of the
Medicaid Inspector General (OMIG) naturally lead them to concentrate on
the biggest potential cases, while many smaller cases have to be put on
the back burner. These smaller cases, however, could represent substan-
tial sums in the aggregate.
This legislation strengthens the handling of those reports by establish-
ing clear requirements for credible allegations received through the
hotline. Once an allegation is determined to be credible, the informa-
tion must be shared with the Attorney General's Medicaid Fraud Control
Unit and local district attorneys. The legislation also establishes
accountability following that referral by requiring a determination
within thirty days as to whether an investigation will be conducted and
which jurisdiction will lead it, as well as notification to the Medicaid
Inspector General of the ultimate outcome. This determination will
provide greater opportunities for local district attorneys to pursue
cases within their social service districts.
In addition, the annual reporting requirement established by this bill
will provide policymakers with important information regarding the
disposition of Medicaid fraud hotline tips, including how many tips are
received and investigated, who conducts those investigations, and their
outcomes. This information will help ensure that credible allegations of
Medicaid fraud do not simply fall through the cracks and will allow
state officials to better evaluate whether the hotline and referral
process are functioning effectively.
By creating a clear process for the referral, investigation and tracking
of credible Medicaid fraud allegations, this legislation will strengthen
oversight, improve accountability, and help protect both taxpayers and
the integrity of New York's Medicaid program.
 
PRIOR LEGISLATIVE HISTORY:
New bill
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Minimal. However, the potential for increased enforcement activity by
local district attorneys may result in substantial increases in fraud
recovery.
 
EFFECTIVE DATE:
Immediately.