HB18-1211: Medicaid Fraud Control Unit

• Creates a Medicaid Fraud Control Unit within the Office of the Attorney General with authority to investigate and prosecute Medicaid provider fraud, waste, and patient abuse/neglect/exploitation cases civilly and criminally.

• Defines "medicaid fraud and waste" as knowing and willful violations including false claims, false statements in provider applications, unauthorized charges to beneficiaries, and improper record destruction or alteration.

• Establishes criminal penalties ranging from Class 1 petty offenses to Class 2 felonies based on aggregate illegal payment amounts, with thresholds starting at less than $50 (petty offense) up to $1 million or more (felony).

• Requires Department of Health Care Policy and Financing, Department of Public Health and Environment, and managed care entities to refer suspected Medicaid fraud and patient abuse cases to the Unit for investigation and prosecution.

• Sets three-year statute of limitations from discovery (but no more than six years from commission) for actions brought under the statute and mandates unit consultation with district attorneys before filing patient abuse/neglect/exploitation criminal charges.