ID H0527

Department of Health and Welfare shall adopt technological tools to investigate, audit, and control fraud, waste, and abuse in Medicaid and other public assistance programs administered by the department.

Department must comply with all antifraud rules for Medicaid under the Patient Protection and Affordable Care Act (PPACA) and retain the maximum amount of loss recovery allowed by the federal government.

Required fraud prevention activities include screening and audit techniques using analytics and statistical profiling, data system enhancements using Medicaid Management Information Systems (MMIS) data, use of the National Correct Coding Initiative (NCCI), and recovery audit contractors (RAC) compensated on a contingency fee basis.

Department may establish a reward program for reporting Medicaid and public assistance fraud using cost/benefit analysis and must inform the public about the program if established.

Department shall utilize available federal funding including enhanced federal funding for Medicaid eligibility determination and report annually to germane legislative committees on fraud prevention efforts for all public assistance programs.