MS HB584

Amends Mississippi Code Section 43-13-203 to define key terms including "abuse" (provider practices inconsistent with sound fiscal, business or medical practices), "fraud" (knowingly submitting false claims with intent to deceive), and "waste" (overutilization or misuse of resources lacking intent to deceive).

Defines "medically necessary" as treatment required for an individual to heal from illness or injury, or to save the individual's life.

Establishes that the Division of Medicaid must determine if credible allegations of fraud or abuse exist before referral, using methods that identify suspicious cases and afford due process, with procedures for referring cases to the Medicaid Fraud Control Unit.

Specifies that allegations of waste do not rise to the level of fraud or abuse and shall be investigated by the Division of Medicaid, which shall determine appropriate corrective measures including corrective action plans.

Effective date: July 1, 2022.