S.B.
206
OFFICE OF MEDICAID INSPECTOR GENERAL AMENDMENTS
Senate Floor
Amendments
Amendment 1 February 26, 2013 12:00 PM
Senator Allen M. Christensen
proposes the following amendments:
1. Page
1, Lines 14 through 23
:
14
This bill:
15
. empowers the Office of Inspector General of Medicaid Services to request
16
eligibility information from a health insurance entity;
17
. establishes that a health insurance entity may not deny a claim if:
18
. the Office of Inspector General of Medicaid Services is seeking to enforce the
19
rights of the state with respect to the claim; and
20
. the enforcement action is begun not later than
{
six
}
three
years after the day on
which
21
the claim is submitted; and
22
. enables the Office of Inspector General of Medicaid Services to report fraud directly
23
to law enforcement.
2. Page
2, Line 55 through Page 3, Line 63
:
55
[(4)] (d) not deny a claim submitted by the Department of Health or the Office of
56
Inspector General of Medicaid Services solely on the basis of the date of submission of the
57
claim, the type or format of the claim form, lack of prior authorization, or failure to present
58
proper documentation at the point-of-sale that is the basis for the claim, if:
59
[(a)] (i) the claim is submitted no later than three years after the day on which the item
60
or service is furnished; and
61
[(b)] (ii) any action by the Department of Health or the Office of Inspector General of
62
Medicaid Services to enforce the rights of the state with respect to the claim is commenced no
63
later than
{
six
}
three
years after the day on which the claim is submitted.
3. Page
4, Line 116 through Page 5, Line 121
:
116
{
(11) "Recovery" means the seizure of improperly obtained funds or property.
}
117
{
[
}
(11)
{
]
} {(12)
}
"Upcoding" means assigning an inaccurate billing code for a service
that is
118
payable or reimbursable by Medicaid funds, if the correct billing code for the service, taking
119
into account reasonable opinions derived from official published coding definitions, would
120
result in a lower Medicaid payment or reimbursement.
121
{
[
}
(12)
{
]
} {(13) }
"Waste" means overutilization of resources or inappropriate
payment.
4. Page
6, Line 156
:
156
[(l)] (m)
{
seek recovery of
}
recover
improperly paid Medicaid funds;