S.B. 191

1

MEDICAID FRAUD OVERSIGHT
2 2000 GENERAL SESSION
3 STATE OF UTAH
4 Sponsor: D. Edgar Allen
5 AN ACT RELATING TO HEALTH; REMOVING MEDICAID FRAUD INVESTIGATIONS
6 AND PROSECUTIONS FROM THE DEPARTMENT OF PUBLIC SAFETY; ESTABLISHING
7 THE DUTIES OF THE DEPARTMENT OF HEALTH AND THE ATTORNEY GENERAL'S
8 OFFICE WITH RESPECT TO CIVIL AND CRIMINAL ENFORCEMENT ACTIONS; AND
9 PROVIDING AN EFFECTIVE DATE.
10 This act affects sections of Utah Code Annotated 1953 as follows:
11 AMENDS:
12 26-18-3, as last amended by Chapter 61, Laws of Utah 1999
13 53-10-104, as renumbered and amended by Chapter 263, Laws of Utah 1998
14 53-10-302, as renumbered and amended by Chapter 263, Laws of Utah 1998
15 67-5-1 (Effective 01/01/01), as last amended by Chapters 371 and 372, Laws of Utah 1999
16 67-5-1 (Superseded 01/01/01), as last amended by Chapter 371, Laws of Utah 1999
17 ENACTS:
18 26-20-13, Utah Code Annotated 1953
19 Be it enacted by the Legislature of the state of Utah:
20 Section 1. Section 26-18-3 is amended to read:
21 26-18-3. Administration of Medicaid program by department -- Disciplinary
22 measures and sanctions -- Funds collected.
23 (1) The department shall be the single state agency responsible for the administration of
24 the Medicaid program in connection with the United States Department of Health and Human
25 Services pursuant to Title XIX of the Social Security Act.
26 (2) The department shall develop implementing policy in conformity with this chapter, the
27 requirements of Title XIX, and applicable federal regulations.

28 (3) The department may, in its discretion, contract with the Department of Human Services
29 or other qualified agencies for services in connection with the administration of the Medicaid
30 program, including but not limited to the determination of the eligibility of individuals for the
31 program, recovery of overpayments, and enforcement of fraud and abuse laws, consistent with
32 Section 26-20-13 , to the extent permitted by law and quality control services.
33 (4) The department shall provide, by rule, disciplinary measures and sanctions for
34 Medicaid providers who fail to comply with the rules and procedures of the program, provided that
35 sanctions imposed administratively may not extend beyond:
36 (a) termination from the program;
37 (b) recovery of claim reimbursements incorrectly paid; and
38 (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
39 (5) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX of
40 the federal Social Security Act shall be deposited in the General Fund as nonlapsing dedicated
41 credits to be used by the division in accordance with the requirements of that section.
42 (6) (a) In determining whether an applicant or recipient is eligible for a service or benefit
43 under this part or Chapter [39] 40, Children's Health Insurance Program, the department shall, if
44 Subsection (6)(b) is satisfied, exclude from consideration one passenger vehicle designated by the
45 applicant or recipient.
46 (b) Before Subsection (6)(a) may be applied:
47 (i) the federal government must:
48 (A) determine that Subsection (6)(a) may be implemented within the state's existing public
49 assistance-related waivers as of January 1, 1999;
50 (B) extend a waiver to the state permitting the implementation of Subsection (6)(a); or
51 (C) determine that the state's waivers that permit dual eligibility determinations for cash
52 assistance and Medicaid are no longer valid; and
53 (ii) the department must determine that Subsection (6)(a) can be implemented within
54 existing funding.
55 Section 2. Section 26-20-13 is enacted to read:
56 26-20-13. Medicaid fraud enforcement.
57 (1) This chapter shall be enforced in accordance with this section.
58 (2) The department shall be responsible for:

59 (a) investigating and prosecuting all civil violations of this chapter; and
60 (b) promptly referring suspected criminal violations of this chapter to the attorney general
61 for criminal investigation and prosecution.
62 (3) The attorney general shall be responsible for:
63 (a) investigating criminal violations of this chapter that are reported to the attorney general
64 by the department or others;
65 (b) promptly referring probable civil violations of this chapter that are not related to a
66 criminal investigation or prosecution to the department for civil investigation and prosecution; and
67 (c) prosecuting criminal violations of this chapter.
68 (4) The department and the attorney general may enter into an interagency agreement
69 regarding the investigation and prosecution of violations of this chapter in accordance with this
70 section, the requirements of Title XIX of the federal Social Security Act, and applicable federal
71 regulations.
72 Section 3. Section 53-10-104 is amended to read:
73 53-10-104. Division duties.
74 The division shall:
75 (1) provide and coordinate the delivery of support services to law enforcement agencies;
76 (2) maintain and provide access to criminal records for use by law enforcement agencies;
77 (3) publish law enforcement and statistical data;
78 (4) maintain dispatch and communications services for public safety communications
79 centers and provide emergency medical, fire suppression, highway maintenance, public works, and
80 law enforcement communications for municipal, county, state, and federal agencies;
81 (5) analyze evidence from crime scenes and crime-related incidents for criminal
82 prosecution;
83 (6) provide criminalistic laboratory services to federal, state, and local law enforcement
84 agencies, prosecuting attorneys' and agencies, and public defenders, with the exception of those
85 services provided by the state medical examiner in accordance with Title 26, Chapter 4, Utah
86 Medical Examiner Act;
87 (7) establish satellite laboratories as necessary to provide criminalistic services;
88 (8) safeguard the public through licensing and regulation of activities that impact public
89 safety, including concealed weapons, emergency vehicles, and private investigators;

90 (9) provide investigative assistance to law enforcement and other government agencies;
91 (10) collect and provide intelligence information to criminal justice agencies;
92 (11) investigate crimes that jeopardize the safety of the citizens, as well as the interests,
93 of the state;
94 [(12) investigate claims of fraud against Medicaid and other insurance carriers;]
95 [(13)] (12) regulate and investigate laws pertaining to the sale and distribution of liquor;
96 [(14)] (13) make rules to implement this chapter; and
97 [(15)] (14) perform the functions specified in this chapter.
98 Section 4. Section 53-10-302 is amended to read:
99 53-10-302. Bureau duties.
100 The bureau shall:
101 (1) upon request, provide assistance and specialized law enforcement services to local law
102 enforcement agencies;
103 (2) conduct financial investigations regarding suspicious cash transactions, fraud, and
104 money laundering;
105 (3) investigate organized crime, extremist groups, and others promoting violence;
106 (4) investigate criminal activity of terrorist groups;
107 (5) enforce the Utah Criminal Code;
108 (6) cooperate and exchange information with other state agencies and with other law
109 enforcement agencies of government, both within and outside of this state, to obtain information
110 that may achieve more effective results in the prevention, detection, and control of crime and
111 apprehension of criminals;
112 [(7) as provided for in state and federal law, investigate and prosecute health care
113 providers who commit fraud under the Medicaid program;]
114 [(8) as provided for in state and federal law, review and investigate complaints of the
115 abuse and neglect of patients of health-care facilities that receive payments under the state
116 medicaid program;]
117 [(9)] (7) create and maintain a statewide criminal intelligence system;
118 [(10)] (8) provide specialized case support and investigate illegal drug production,
119 cultivation, and sales;
120 [(11)] (9) investigate, follow-up, and assist in highway drug interdiction cases;

121 [(12)] (10) make rules to implement this chapter; and
122 [(13)] (11) perform the functions specified in Part 2, Narcotics and Alcoholic Beverage
123 Law Enforcement Act.
124 Section 5. Section 67-5-1 (Effective 01/01/01) is amended to read:
125 67-5-1 (Effective 01/01/01). General duties.
126 The attorney general shall, subject to Title 67, Chapter 23, Public Attorneys Act:
127 (1) except as provided in Sections 10-3-928 and 17-18-1 , attend the Supreme Court and
128 the Court of Appeals of this state, and all courts of the United States, and, as attorney, prosecute
129 or defend all causes to which the state, or any officer, board, or commission of the state in an
130 official capacity is a party; and, as attorney, represent the state in all civil legal matters in which
131 the state is interested;
132 (2) with approval of the client:
133 (a) initiate legal proceedings in a court of competent jurisdiction on behalf of the state, or
134 any officer, board, commission, agency, or instrumentality of the state for the purpose of opposing
135 or challenging federal laws, regulations, or court orders and their impact on or applicability to the
136 state; and
137 (b) as the budget permits, retain outside legal counsel with appropriate expertise to
138 represent the state in the legal proceedings;
139 (3) after judgment on any cause referred to in Subsection (1), direct, with approval of the
140 client, the issuance of process as necessary to execute the judgment;
141 (4) account for, and pay over to the proper officer, all moneys that come into the attorney
142 general's possession that belong to the state;
143 (5) keep a file of all cases in which the attorney general is required to appear, including
144 any documents and papers showing the court in which the cases have been instituted and tried, and
145 whether they are civil or criminal, and:
146 (a) if civil, the nature of the demand, the stage of proceedings, and when prosecuted to
147 judgment, a memorandum of the judgment and of any process issued whether satisfied, and if not
148 satisfied, the return of the sheriff;
149 (b) if criminal, the nature of the crime, the mode of prosecution, the stage of proceedings,
150 and when prosecuted to sentence, a memorandum of the sentence and of the execution, if the
151 sentence has been executed, if not executed, of the reason of the delay or prevention; and

152 (c) deliver this information to the attorney general's successor in office;
153 (6) exercise supervisory powers over the district and county attorneys of the state in all
154 matters pertaining to the duties of their offices, and from time to time require of them reports of
155 the condition of public business entrusted to their charge;
156 (7) give the attorney general's opinion in writing and without fee to the Legislature or
157 either house, and to any state officer, board, or commission, and to any county attorney or district
158 attorney, when required, upon any question of law relating to their respective offices;
159 (8) when required by the public service or directed by the governor, assist any district or
160 county attorney in the discharge of his duties;
161 (9) purchase in the name of the state, under the direction of the state Board of Examiners,
162 any property offered for sale under execution issued upon judgments in favor of or for the use of
163 the state, and enter satisfaction in whole or in part of the judgments as the consideration of the
164 purchases;
165 (10) when the property of a judgment debtor in any judgment mentioned in Subsection (9)
166 has been sold under a prior judgment, or is subject to any judgment, lien, or encumbrance taking
167 precedence of the judgment in favor of the state, redeem the property, under the direction of the
168 state Board of Examiners, from the prior judgment, lien, or encumbrance, and pay all money
169 necessary for the redemption, upon the order of the state Board of Examiners, out of any money
170 appropriated for these purposes;
171 (11) when in his opinion it is necessary for the collection or enforcement of any judgment,
172 institute and prosecute on behalf of the state any action or proceeding necessary to set aside and
173 annul all conveyances fraudulently made by the judgment debtors, and pay the cost necessary to
174 the prosecution, when allowed by the state Board of Examiners, out of any money not otherwise
175 appropriated;
176 (12) discharge the duties of a member of all official boards of which the attorney general
177 is or may be made a member by the Utah Constitution or by the laws of the state, and other duties
178 prescribed by law;
179 (13) institute and prosecute proper proceedings in any court of the state or of the United
180 States, to restrain and enjoin corporations organized under the laws of this or any other state or
181 territory from acting illegally or in excess of their corporate powers or contrary to public policy,
182 and in proper cases forfeit their corporate franchises, dissolve the corporations, and wind up their

183 affairs;
184 (14) institute investigations for the recovery of all real or personal property that may have
185 escheated or should escheat to the state, and for that purpose, subpoena any persons before any of
186 the district courts to answer inquiries and render accounts concerning any property, examine all
187 books and papers of any corporations, and when any real or personal property is discovered that
188 should escheat to the state, institute suit in the district court of the county where the property is
189 situated for its recovery, and escheat that property to the state;
190 (15) administer the Children's Justice Center as a program to be implemented in various
191 counties pursuant to Sections 67-5b-101 through 67-5b-107 ; [and]
192 (16) assist the Constitutional Defense Council as provided in Title 63C, Chapter 4,
193 Constitutional Defense Council[.];
194 (17) investigate and prosecute criminal violations of Title 26, Chapter 20, False Claims
195 Act, in accordance with Section 26-20-13 ; and
196 (18) investigate and prosecute complaints of abuse, neglect, or exploitation of patients at
197 health care facilities that receive payments under the state Medicaid program.
198 Section 6. Section 67-5-1 (Superseded 01/01/01) is amended to read:
199 67-5-1 (Superseded 01/01/01). General duties.
200 The attorney general shall:
201 (1) except as provided in Sections 10-3-928 and 17-18-1 , attend the Supreme Court and
202 the Court of Appeals of this state, and all courts of the United States, and prosecute or defend all
203 causes to which the state, or any officer, board, or commission of the state in an official capacity
204 is a party; and take charge, as attorney, of all civil legal matters in which the state is interested;
205 (2) when jointly agreed by the governor and the attorney general:
206 (a) initiate legal proceedings in a court of competent jurisdiction on behalf of the state, or
207 any officer, board, commission, agency, or instrumentality of the state for the purpose of opposing
208 or challenging federal laws, regulations, or court orders and their impact on or applicability to the
209 state; and
210 (b) as the budget permits, retain outside legal counsel with appropriate expertise to
211 represent the state in the legal proceedings;
212 (3) after judgment on any cause referred to in Subsection (1), direct the issuance of process
213 as necessary to execute the judgment;

214 (4) account for, and pay over to the proper officer, all moneys which come into his
215 possession, that belong to the state;
216 (5) keep a file of all cases in which he is required to appear, including any documents and
217 papers showing the court in which the cases have been instituted and tried, and whether they are
218 civil or criminal, and:
219 (a) if civil, the nature of the demand, the stage of proceedings, and when prosecuted to
220 judgment, a memorandum of the judgment and of any process issued whether satisfied, and if not
221 satisfied, the return of the sheriff;
222 (b) if criminal, the nature of the crime, the mode of prosecution, the stage of proceedings,
223 and when prosecuted to sentence, a memorandum of the sentence and of the execution, if the
224 sentence has been executed, if not executed, of the reason of the delay or prevention; and
225 (c) deliver this information to his successor in office;
226 (6) exercise supervisory powers over the district and county attorneys of the state in all
227 matters pertaining to the duties of their offices, and from time to time require of them reports of
228 the condition of public business entrusted to their charge;
229 (7) give his opinion in writing and without fee to the Legislature or either house, and to
230 any state officer, board, or commission, and to any county attorney or district attorney, when
231 required, upon any question of law relating to their respective offices;
232 (8) when required by the public service or directed by the governor, assist any district or
233 county attorney in the discharge of his duties;
234 (9) purchase in the name of the state, under the direction of the state Board of Examiners,
235 any property offered for sale under execution issued upon judgments in favor of or for the use of
236 the state, and enter satisfaction in whole or in part of the judgments as the consideration of the
237 purchases;
238 (10) when the property of a judgment debtor in any judgment mentioned in Subsection (9)
239 has been sold under a prior judgment, or is subject to any judgment, lien, or encumbrance taking
240 precedence of the judgment in favor of the state, redeem the property, under the direction of the
241 state Board of Examiners, from the prior judgment, lien, or encumbrance, and pay all money
242 necessary for the redemption, upon the order of the state Board of Examiners, out of any money
243 appropriated for these purposes;
244 (11) when in his opinion it is necessary for the collection or enforcement of any judgment,

245 institute and prosecute on behalf of the state any action or proceeding necessary to set aside and
246 annul all conveyances fraudulently made by the judgment debtors, and pay the cost necessary to
247 the prosecution, when allowed by the state Board of Examiners, out of any money not otherwise
248 appropriated;
249 (12) discharge the duties of a member of all official boards of which he is or may be made
250 a member by the Utah Constitution or by the laws of the state, and other duties prescribed by law;
251 (13) institute and prosecute proper proceedings in any court of the state or of the United
252 States, to restrain and enjoin corporations organized under the laws of this or any other state or
253 territory from acting illegally or in excess of their corporate powers or contrary to public policy,
254 and in proper cases forfeit their corporate franchises, dissolve the corporations, and wind up their
255 affairs;
256 (14) institute investigations for the recovery of all real or personal property that may have
257 escheated or should escheat to the state, and for that purpose he may cite any persons before any
258 of the district courts to answer inquiries and render accounts concerning any property, may
259 examine all books and papers of any corporations, and when any real or personal property is
260 discovered that should escheat to the state, the attorney general shall institute suit in the district
261 court of the county where the property is situated for its recovery, and escheat that property to the
262 state;
263 (15) administer the Children's Justice Center as a program to be implemented in various
264 counties pursuant to Sections 67-5b-101 through 67-5b-107 ; [and]
265 (16) assist the Constitutional Defense Council as provided in Title 63C, Chapter 4,
266 Constitutional Defense Council[.];
267 (17) investigate and prosecute criminal violations of Title 26, Chapter 20, False Claims
268 Act, in accordance with Section 26-20-13 ; and
269 (18) investigate and prosecute complaints of abuse, neglect, or exploitation of patients at
270 health care facilities that receive payments under the state Medicaid program.

Legislative Review Note
as of 2-7-00 6:54 AM

A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel