HB 1983 Summary

• Creates the Oklahoma Reduction of Medicaid Fraud and Abuse Act of 2013 to address estimated $18 billion in annual fraud, waste, and abuse in state Medicaid programs.

• Requires implementation of provider data verification and screening technology to prevent payments to deceased, sanctioned, license-expired, retired, or invalid-address providers.

• Mandates use of predictive modeling and analytics technology in pre-payment position within claims workflow to identify high-risk billing patterns and prevent fraudulent payments before claim processing.

• Applies to state Medicaid managed care programs, state Medicaid programs, and the state CHIP (Children's Health Insurance Program).

• Allows contractor reimbursement through savings-based models (percentage of savings, per-beneficiary fees, per-transaction, or case-rate methods) with performance guarantees, with costs funded through actual fraud reduction savings.