HB 24-1146 Summary

• Authorizes the Department of Health Care Policy and Financing to suspend provider enrollment in Medicaid and the Children's Basic Health Plan if the provider participates in an alleged ongoing organized crime or fraud scheme.

• Suspension requires documentation that at least three of seven factors are met, including provider enrollment less than three years, involvement of three or more providers, collective billing exceeding $1 million, billing pattern of abuse, significant unexplained billing increases, federal Medicare/Medicaid Services enrollment moratorium, or law enforcement notification.

• Provider must receive written notice of suspension including reasons; initial suspension period is six months while the department conducts review, with possible six-month extensions if needed.

• Department must reinstate provider enrollment immediately upon determining the provider did not engage in organized crime or fraud, regardless of whether the six-month period has ended.

• Exempts providers enrolled for three or more years who have consistently rendered services and received payment from suspension under this provision.