Arkansas 2023 Regular Session

Arkansas Senate Bill SB518 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	Stricken language would be deleted from and underlined language would be added to present law.
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3	3
4	4	State of Arkansas 1
5	5	94th General Assembly A Bill 2
6	6	Regular Session, 2023 SENATE BILL 518 3
7	7	4
8	8	By: Senator Irvin 5
9	9	6
10	10	For An Act To Be Entitled 7
11	11	AN ACT TO AMEND THE MEDICAID FRAUD ACT A ND THE 8
12	12	MEDICAID FRAUD FALSE CLAIMS ACT; TO UPDAT E LANGUAGE 9
13	13	AND DEFINITIONS TO R EFLECT CHANGES WITHI N THE 10
14	14	HEALTHCARE SYSTEM; T O MAKE DEFINITIONS A ND LANGUAGE 11
15	15	CONSISTENT BETWEEN T HE MEDICAID FRAUD AC T AND THE 12
16	16	MEDICAID FRAUD FALSE CLAIMS A CT; TO REDUCE CIVIL 13
17	17	PENALTIES TO BE CONS ISTENT WITH FEDERAL LAW; TO 14
18	18	ENHANCE A SENTENCE I F THE MEDICAID FRAUD CAUSES 15
19	19	PHYSICAL INJURY OR D EATH; AND FOR OTHER PURPOSES. 16
20	20	17
21	21	18
22	22	Subtitle 19
23	23	TO AMEND THE MEDICAID FRAUD ACT AND THE 20
24	24	MEDICAID FRAUD FALSE CLAIMS ACT; AND TO 21
25	25	UPDATE LANGUAGE AND DEFINITIONS TO 22
26	26	REFLECT CHANGES WITHIN THE HEALTHCARE 23
27	27	SYSTEM;. 24
28	28	25
29	29	26
30	30	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 27
31	31	28
32	32	SECTION 1. Arkansas Code § 5 -55-102(2), concerning the definition of 29
33	33	"claim" within the Medicaid Fraud Act, is amended to read as follows: 30
34	34	(2)(A) “Claim” means any written or electronically submitted 31
35	35	request or demand for reimbursement or payment made by any Medicaid provider 32
36	36	to the Arkansas Medicaid Program, a managed care orga nization, or any fiscal 33
37	37	agent of the Arkansas Medicaid Program or a managed care organization for 34
38	38	each good or service purported to have been provided to any Medicaid 35
39	39	recipient and all documentation required to be created or maintained by law 36 SB518
40	40
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42	42
43	43
44	44	or rule to justify, support, approve, or document the delivery of healthcare 1
45	45	goods or services to a Medicaid recipient as a condition of participation in 2
46	46	the Arkansas Medicaid Program as mandated by the Arkansas Medicaid Program 3
47	47	provider agreement, rules, or managed ca re contract request or demand for 4
48	48	money or property, regardless of whether under a contract, that: 5
49	49	(i) Is presented to an officer, employee, agent, or 6
50	50	fiscal agent of the Arkansas Medicaid Program; and 7
51	51	(ii) Is made to a contractor, grantee, or ot her 8
52	52	recipient if: 9
53	53	(a) The money or property is spent or used on 10
54	54	behalf of the Arkansas Medicaid Program or to advance the Arkansas Medicaid 11
55	55	Program or its interest; and 12
56	56	(b) The Arkansas Medicaid Program: 13
57	57	(1) Provides or has provided any portion 14
58	58	of the money or property requested or demanded; or 15
59	59	(2) Is reimbursing the contractor, 16
60	60	grantee, or other recipient for any portion of the money or property that is 17
61	61	requested or demanded. 18
62	62	(B) "Claim" includes: 19
63	63	(i) Billing documentatio n; 20
64	64	(ii) All documentation required to be created or 21
65	65	maintained by law or rule to justify, support, or document the delivery of 22
66	66	healthcare goods or services to a Medicaid recipient; 23
67	67	(iii) All documentation submitted to justify or help 24
68	68	establish a unit rate, capitated rate, or other method of determining what is 25
69	69	to be paid for healthcare goods and services to a Medicaid recipient; and 26
70	70	(iv) All transactions in payment for healthcare 27
71	71	goods and services delivered or claimed to have been delivered to a Medicaid 28
72	72	recipient under the Arkansas Medicaid Program, regardless of whether the 29
73	73	state has title to the money or property or has transferred responsibility 30
74	74	for delivering healthcare goods or services to another legal entity ; 31
75	75	32
76	76	SECTION 2. Arkansas Co de § 5-55-102(4) and (5), concerning the 33
77	77	definitions within the Medicaid Fraud Act, are amended to read as follows: 34
78	78	(4)(A) “Illegal Medicaid participation” means participation in 35
79	79	the Arkansas Medicaid Program when the individual or organization is 36 SB518
80	80
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82	82
83	83
84	84	suspended from the Arkansas Medicaid Program or on a state or federal 1
85	85	excluded Medicaid provider list. 2
86	86	(B) “Illegal Medicaid participation” includes without 3
87	87	limitation when a suspended or excluded individual or organization: 4
88	88	(i) Is employed or contract ing with a Medicaid 5
89	89	provider or managed care organization or otherwise associated with a Medicaid 6
90	90	provider or managed care organization for the purpose of providing or 7
91	91	supervising the provision of goods and services to Medicaid recipients; 8
92	92	(ii) Plays any role in the management of a Medicaid 9
93	93	provider directly as a manager or management company or indirectly as a 10
94	94	consultant or advisor; or 11
95	95	(iii) Receives payment for administrative and 12
96	96	management services directly or indirectly related to patient care such as 13
97	97	processing Medicaid claims for payment, attending to services that assist or 14
98	98	support Medicaid recipients, or acting as a Medicaid consultant or advisor; 15
99	99	(5)(4) “Managed care organization” means a health insurer, 16
100	100	Medicaid provider, or other busi ness entity authorized by state law or 17
101	101	through a contract with the state to receive a fixed or capitated rate or fee 18
102	102	to manage all or a portion of the delivery of healthcare goods or services to 19
103	103	Medicaid recipients; 20
104	104	(5) "Material" means having a natural tendency to influence, or 21
105	105	to be capable of influencing, the payment or receipt of money or property and 22
106	106	includes without limitation a false statement, omission, or representation if 23
107	107	the false statement, omission, or representation is likely to induce or c ause 24
108	108	the Arkansas Medicaid Program to pay, approve, or act in a particular way; 25
109	109	26
110	110	SECTION 3. Arkansas Code § 5 -55-102(8) and (9), concerning the 27
111	111	definitions within the Medicaid Fraud Act, are amended to read as follows: 28
112	112	(8) "Overpayment" means the full amount of the Medicaid funds 29
113	113	obtained as a direct or indirect result of a violation of Medicaid fraud, § 30
114	114	5-55-111, § 20-77-902, the rules of the Arkansas Medicaid Program, or a 31
115	115	managed care provider contract; 32
116	116	(9) “Person” means any: 33
117	117	(A) Medicaid provider of goods or services under the 34
118	118	Arkansas Medicaid Program or any employee of the Medicaid provider, 35
119	119	independent contractor of the Medicaid provider, contractor of the Medicaid 36 SB518
120	120
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122	122
123	123
124	124	provider, or subcontractor of the Medicaid provider, whether the Medicaid 1
125	125	provider be an individual, individual medical vendor, firm, corporation, 2
126	126	professional association, partnership, organization, risk -based provider 3
127	127	organization, managed care organization, or other legal entity; or 4
128	128	(B) Individual, individual medical vend or, firm, 5
129	129	corporation, professional association, partnership, organization, risk -based 6
130	130	provider organization, managed care organization, or other legal entity, or 7
131	131	any employee of any individual, individual medical vendor, firm, corporation, 8
132	132	professional association, partnership, organization, risk -based provider 9
133	133	organization, managed care organization, or other legal entity, not a 10
134	134	Medicaid provider under the Arkansas Medicaid Program but that provides goods 11
135	135	or services to a Medicaid provider under the Arkan sas Medicaid Program for 12
136	136	which the Medicaid provider submits claims to the Arkansas Medicaid Program 13
137	137	or its fiscal agents; and 14
138	138	(9)(A)(10) “Records” means all documents that disclose the 15
139	139	nature, extent, and level of healthcare goods and services provided to 16
140	140	Medicaid recipients., including without limitation: 17
141	141	(A) Images, slides, film, video, and similar physical and 18
142	142	digital files resulting from common diagnostic testing such as 19
143	143	(B) “Records” include X-rays, magnetic resonance imaging 20
144	144	scans, computed tomography scans, computed axial tomography scans, 21
145	145	ultrasounds, and other diagnostic imaging commonly used and retained as part 22
146	146	of the medical records of a patient tools; 23
147	147	(B) Records documenting treatment administration, 24
148	148	medication administration, and activities of daily living; and 25
149	149	(C) All financial reports, cost reports, disclosure forms, 26
150	150	and other Medicaid records submitted or required to be retained in any rate 27
151	151	development or review process, reconciliation process, or actuarial process 28
152	152	required by the rules of Arkansas Medicaid Program or state law; 29
153	153	(11) "Serious physical injury" means a physical injury to a 30
154	154	person that: 31
155	155	(A) Creates a substantial risk of death; or 32
156	156	(B) Causes: 33
157	157	(i) Protracted disfigurement; 34
158	158	(ii) Protracted impairment of health; or 35
159	159	(iii) Loss or protracted impairment of the function 36 SB518
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163	163
164	164	of any bodily member or organ; and 1
165	165	(12)(A) “Unlawful Medicaid participation” means participation in 2
166	166	the Arkansas Medicaid Program when an individual or organization is sus pended 3
167	167	from the Arkansas Medicaid Program or is on a state or federal excluded 4
168	168	Medicaid provider list. 5
169	169	(B) “Unlawful Medicaid participation” includes without 6
170	170	limitation when a suspended or excluded individual or organization: 7
171	171	(i) Is employed or co ntracting with a Medicaid 8
172	172	provider or managed care organization or otherwise associated with a Medicaid 9
173	173	provider or managed care organization for the purpose of providing or 10
174	174	supervising the provision of goods and services to Medicaid recipients; 11
175	175	(ii) Plays any role in the management of a Medicaid 12
176	176	provider directly as a manager or management company or indirectly as a 13
177	177	consultant or advisor; or 14
178	178	(iii) Receives payment for administrative and 15
179	179	management services directly or indirectly related to patien t care such as 16
180	180	processing Medicaid claims for payment, attending to services that assist or 17
181	181	support Medicaid recipients, or acting as a Medicaid consultant or advisor . 18
182	182	19
183	183	SECTION 4. Arkansas Code § 5 -55-103 is amended to read as follows: 20
184	184	5-55-103. Unlawful acts — Classification. 21
185	185	(a)(1) It is unlawful for any person to commit Medicaid fraud as 22
186	186	prohibited by § 5-55-111. 23
187	187	(b)(2) Medicaid fraud is a: 24
188	188	(A) Class D felony if the aggregate amount of overpayment 25
189	189	resulting from a violation of Medicaid fraud, § 5-55-111 is one thousand 26
190	190	dollars ($1,000) or more but less than two thousand five hundred dollars 27
191	191	($2,500); 28
192	192	(1)(B) Class C felony if the aggregate amount of payments 29
193	193	illegally claimed overpayment resulting from a violation of Medicaid fraud, § 30
194	194	5-55-111 is two thousand five hundred dollars ($2,500) or more but less than 31
195	195	five thousand dollars ($5,000); 32
196	196	(2)(C) Class B felony if the aggregate amount of payments 33
197	197	illegally claimed overpayment resulting from a violation of Medicaid fraud, § 34
198	198	5-55-111 is five thousand dollars ($5,000) or more but less than twenty -five 35
199	199	thousand dollars ($25,000); and 36 SB518
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203	203
204	204	(3)(D) Class A felony if the aggregate amount of payments 1
205	205	illegally claimed overpayment resulting from a violation of Medicaid fraud, § 2
206	206	5-55-111 is twenty-five thousand dollars ($25,000) or more ; or 3
207	207	(E) Class A misdemeanor if the aggregate amount of 4
208	208	overpayment resulting from a violation of Medicaid fraud, § 5 -55-111 is less 5
209	209	than one thousand dollars ($1,000) . 6
210	210	(c) Otherwise, Medicaid fraud i s a Class A misdemeanor. 7
211	211	(3)(A) It is unlawful to submit claims as prohibited by any 8
212	212	provision of § 5-55-111. 9
213	213	(B) If a claim is submitted as prohibited by Medicaid 10
214	214	fraud, § 5-55-111, but not paid, the state may bring a charge of attempt to 11
215	215	commit Medicaid fraud, § 5-55-111, in accordance with § 5 -3-201. 12
216	216	(4)(A) The classification of Medicaid fraud, § 5 -55-111, is 13
217	217	enhanced one (1) classification level if the Medicaid fraud, § 5 -55-111, 14
218	218	causes serious physical injury to or the death of a Medicaid rec ipient. 15
219	219	(B) To seek the enhanced penalty permitted by this 16
220	220	section, the state shall charge the enhancement in the information or 17
221	221	indictment. 18
222	222	(b)(1) It is unlawful to fail to maintain records or documentation 19
223	223	required by the rules of the Arkansas Medi caid Program. 20
224	224	(2) A violation of subdivision (b)(1) of this section is a Class 21
225	225	D felony if the unavailability of records impairs or obstructs the 22
226	226	prosecution of a felony or a civil action under § 20 -77-901 et seq. or the 23
227	227	Adult and Long-Term Care Facility Resident Maltreatment Act, § 12 -12-1701 et 24
228	228	seq. 25
229	229	(c)(1) A single scheme or a series of similar violations of this 26
230	230	subchapter is a continuing course of conduct offense that may be treated and 27
231	231	charged as a single violation. 28
232	232	(2)(A) A charge based on agg regated acts of Medicaid fraud, § 5 -29
233	233	55-111, may be brought in any county where one (1) of the alleged acts 30
234	234	occurred or in Pulaski County. 31
235	235	(B) If there are different fraudulent schemes or 32
236	236	fraudulent acts involving different defendants, the charges may be brought 33
237	237	separately in any county where one (1) of the alleged acts occurred or in 34
238	238	Pulaski County. 35
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243	243
244	244	SECTION 5. Arkansas Code § 5 -55-104(c)-(i), concerning records related 1
245	245	to Medicaid fraud within the Medicaid Fraud Act, are amended to read as 2
246	246	follows: 3
247	247	(c) The Attorney General and the prosecuting attorneys are allowed 4
248	248	access to all records of persons and Medicaid recipients under the Arkansas 5
249	249	Medicaid Program to which the secretary has access for the purpose of 6
250	250	investigating whether any person may have committed the crime of Medicaid 7
251	251	fraud or for use or potential use in any legal, administrative, or judicial 8
252	252	proceeding. 9
253	253	(d) Notwithstanding any other law to the contrary, no person is 10
254	254	subject to any civil or criminal liability for providing access to re cords to 11
255	255	the secretary, the Attorney General, or the prosecuting attorneys. 12
256	256	(e) Records obtained by the secretary, the Attorney General, or the 13
257	257	prosecuting attorneys pursuant to this subchapter are classified as 14
258	258	confidential information and are not subje ct to outside review or release by 15
259	259	any individual except when records are used or potentially to be used by any 16
260	260	government entity in any legal, administrative, or judicial proceeding. 17
261	261	(f)(1)(c)(1) A Medicaid provider or person providing healthcare goods 18
262	262	or services under the Arkansas Medicaid Program shall: 19
263	263	(A) Comply with the retention requirements established by 20
264	264	the rules of the Arkansas Medicaid Program for all records; and 21
265	265	(B) Maintain is required to maintain all records at least 22
266	266	for a period of not less than five (5) years from the date of claimed 23
267	267	provision of any goods or services to any Medicaid recipient. 24
268	268	(2)(A) The records described in subdivision (f)(1) (c)(1) of 25
269	269	this section shall be available for audit during regular business hours a t 26
270	270	the address listed in the Medicaid provider agreement or where the healthcare 27
271	271	goods or services are provided. 28
272	272	(B) Closed records for inactive patients or clients may be 29
273	273	maintained in offsite storage if: 30
274	274	(i) The records can be produced within thr ee (3) 31
275	275	working days of being served with a request for records, subpoena, or other 32
276	276	lawful notice from any agency with authority to audit the records; and 33
277	277	(ii) The records are maintained within the state. 34
278	278	(C) A Medicaid provider shall disclose upon request by the 35
279	279	Arkansas Medicaid Program, the Office of Medicaid Inspector General, or the 36 SB518
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283	283
284	284	Medicaid Fraud Control Unit the location of any offsite storage facility or 1
285	285	server and the contact information of the person or company that manages the 2
286	286	storage facility or server to any agency with authority to audit the records . 3
287	287	(3) If the healthcare goods or services are provided in the home 4
288	288	of the Medicaid recipient, the records shall be maintained at the principal 5
289	289	place of business of the Medicaid provider. 6
290	290	(4) If a Medicaid provider goes out of business, the Medicaid 7
291	291	provider shall give written notification to the Department of Human Services 8
292	292	and the Office of Medicaid Inspector General of where and how the records 9
293	293	will be stored. 10
294	294	(g)(1) It is unlawful to destroy or alter any record or supporting 11
295	295	documentation with a purpose to conceal a false or fraudulent claim made to 12
296	296	the Arkansas Medicaid Program or to interfere with an audit, investigation, 13
297	297	or prosecution related to a claim made to the Arkansas Medica id Program. 14
298	298	(2) A violation of subdivision (g)(1) of this section is a Class 15
299	299	B felony. 16
300	300	(h)(1) Any person found not to have maintained any records upon 17
301	301	conviction is guilty of a Class D felony if the unavailability of records 18
302	302	impairs or obstructs the prosecution of a felony. 19
303	303	(2) Otherwise, a violation of subdivision (h)(1) of this section 20
304	304	is a Class A misdemeanor. 21
305	305	(i) It is an affirmative defense to a prosecution under this section 22
306	306	that the records in question were lost or destroyed in a flood, fi re, or 23
307	307	other natural disaster or by a criminal act that did not result from the 24
308	308	defendant's conduct. 25
309	309	26
310	310	SECTION 6. Arkansas Code § 5 -55-106 is amended to read as follows: 27
311	311	5-55-106. Investigation by Attorney General — Access to records. 28
312	312	The office of the Attorney General is the entity to which a case of 29
313	313	suspected Medicaid fraud shall be referred by the Arkansas Medicaid Program 30
314	314	or its fiscal agents for the purposes of investigation, civil action, or 31
315	315	referral to the prosecuting attorney having criminal jur isdiction in the 32
316	316	matter. 33
317	317	(a)(1)(A) In accordance with 42 U.S.C. § 1396b(q), the State of 34
318	318	Arkansas shall maintain a single organization with statewide law enforcement 35
319	319	authority to protect Medicaid recipients from abuse, neglect, and 36 SB518
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322	322
323	323
324	324	exploitation and to pro tect the Arkansas Medicaid Program from fraud. 1
325	325	(B) When fully certified by the Office of Inspector 2
326	326	General of the United States Department of Health and Human Services, a 3
327	327	investigative and prosecution unit as described in subdivision (a)(1)(A) of 4
328	328	this section is identified under federal law and regulations as a Medicaid 5
329	329	Fraud Control Unit. 6
330	330	(2) The Medicaid Fraud Control Unit, under the supervision of 7
331	331	the Attorney General, shall have statewide law enforcement investigative 8
332	332	jurisdiction and may utilize all civil investigative and litigation authority 9
333	333	of the Attorney General's office. 10
334	334	(3) Under § 5-55-114, an attorney of the Medicaid Fraud Control 11
335	335	Unit may be appointed by local prosecuting attorneys as a special prosecutor 12
336	336	or a special deputy prosecut or to prosecute any criminal case. 13
337	337	(b)(1) The Secretary of the Department of Human Services, the Arkansas 14
338	338	Medicaid Program, and the Medicaid Inspector General shall work closely with 15
339	339	the Medicaid Fraud Control Unit to protect against abuse, neglect, 16
340	340	exploitation, and fraud. 17
341	341	(2) The secretary and the Medicaid Inspector General shall 18
342	342	develop and monitor systems that ensure any credible allegations of Medicaid 19
343	343	fraud and abuse, neglect, or exploitation of Medicaid recipients are 20
344	344	immediately referred to the Medicaid Fraud Control Unit for investigation. 21
345	345	(c)(1) The Medicaid Fraud Control Unit is a health oversight agency 22
346	346	that is: 23
347	347	(A) Exempt from the Health Insurance Portability and 24
348	348	Accountability Act of 1996, Pub. L. No. 104 -191; and 25
349	349	(B) Allowed access to all records whether in the 26
350	350	possession of the Arkansas Medicaid Program, a Medicaid provider, or employee 27
351	351	or contractor of a Medicaid provider. 28
352	352	(2) The Medicaid Fraud Control Unit shall have access to: 29
353	353	(A)(i) Records on a Medicaid recipient. 30
354	354	(ii) The records shall be available for audit during 31
355	355	regular business hours at the address listed in the Medicaid provider 32
356	356	agreement or where the healthcare goods or services are provided, or as 33
357	357	otherwise provided by this subchapter; 34
358	358	(B) Encounter claims data and other records of managed 35
359	359	care organizations and any other record related to provision of goods and 36 SB518
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362	362
363	363
364	364	services to Medicaid recipients; 1
365	365	(C) Notwithstanding any other confidentiality law, all 2
366	366	financial reports, cost reports, disclosure forms , and other records 3
367	367	submitted or required to be retained in any licensure process, rate 4
368	368	development process, rate review process, reconciliation process, or 5
369	369	actuarial process required to participate in the Arkansas Medicaid Program or 6
370	370	by state law or rule. 7
371	371	(3) The Medicaid Fraud Control Unit may obtain any other 8
372	372	healthcare or business record necessary to conduct an ongoing investigation 9
373	373	or audit by subpoena. 10
374	374	(4) Notwithstanding any other law to the contrary, a person is 11
375	375	not subject to any civil or cr iminal liability for providing access to 12
376	376	records to the Medicaid Fraud Control Unit. 13
377	377	(5)(A)(i) Records obtained by the Medicaid Fraud Control Unit 14
378	378	under this subchapter are classified as confidential information and are not 15
379	379	subject to outside review or release to any individual except as may be 16
380	380	necessary for the Medicaid Fraud Control Unit to pursue or to potentially 17
381	381	pursue legal, administrative, or judicial proceedings. 18
382	382	(ii) Records obtained by the Medicaid Fraud Control 19
383	383	Unit under this subchapter are exempt from disclosure under the Freedom of 20
384	384	Information Act of 1967, § 25 -19-101 et seq. 21
385	385	(B) The Medicaid Fraud Control Unit may share records with 22
386	386	the Attorney General, the Office of the Medicaid Inspector General, a 23
387	387	prosecuting attorney, and any other government entity as may be necessary and 24
388	388	appropriate to carry out the mission of the Medicaid Fraud Control Unit. 25
389	389	(6) Whenever possible, the Medicaid Fraud Control Unit shall 26
390	390	seek protective orders and take any other measures possible to provide 27
391	391	maximum confidentiality to the personal health care information of individual 28
392	392	Arkansans while accomplishing its mission. 29
393	393	(d)(1) A Medicaid program provider shall cooperate in reviews, audits, 30
394	394	and investigations conducted by the Department of Human Servic es, Office of 31
395	395	the Medicaid Inspector General, and the Medicaid Fraud Control Unit. 32
396	396	(2) A request for information includes formal and informal 33
397	397	requests made to a Medicaid provider by any attorney, auditor, officer, or 34
398	398	agent of the Office of the Medicaid Inspector General or the Medicaid Fraud 35
399	399	Control Unit. 36 SB518
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403	403
404	404	1
405	405	SECTION 7. Arkansas Code § 5 -55-107(a)(1)(A), concerning restitution 2
406	406	and collection within the Medicaid Fraud Act, is amended to read as follows: 3
407	407	(1)(A) Restitution of an overpayment made to the Arkansas 4
408	408	Medicaid Program shall be paid to the Department of Human Services, with the 5
409	409	restitution to be deposited into the Arkansas Medicaid Program Trust Fund for 6
410	410	the loss to the Arkansas Medicaid Program or its fiscal agents. 7
411	411	8
412	412	SECTION 8. Arkansas Code § 5-55-107(d)(3), concerning restitution and 9
413	413	collection within the Medicaid Fraud Act, is amended to read as follows: 10
414	414	(3)(A) Restitution ordered for a loss to the Arkansas Medicaid 11
415	415	Program shall not be excused by the court , except where the court conduc ts a 12
416	416	hearing and makes a finding of fact that the debt is uncollectable . 13
417	417	(B) As the State of Arkansas has a right to litigate any 14
418	418	claim that a debt is uncollectable, the Attorney General's office shall be 15
419	419	given notice, a reasonable time to investigate a claim by a defendant that 16
420	420	the amount of the restitution is uncollectable, and the opportunity to 17
421	421	present evidence before any finding that a debt is uncollectable is entered. 18
422	422	(B)(C) A conviction under this subchapter shall not be 19
423	423	sealed or expunged un til all ordered restitution is paid in full. 20
424	424	21
425	425	SECTION 9. Arkansas Code § 5 -55-107(e)(2), concerning restitution and 22
426	426	collection within the Medicaid Fraud Act, is amended to read as follows: 23
427	427	(2) Restitution ordered payments to reimburse for reasonable and 24
428	428	necessary expenses incurred by the office of the Attorney General Attorney 25
429	429	General's office or the prosecuting attorney during investigation and 26
430	430	prosecution shall be paid to the office of the Attorney General or the 27
431	431	prosecuting attorney to be retained a nd used in future investigations for 28
432	432	Medicaid fraud. 29
433	433	30
434	434	SECTION 10. Arkansas Code § 5 -55-108 is amended to read as follows: 31
435	435	5-55-108. Fines. 32
436	436	(a) Any person who is found guilty of or who pleads guilty or nolo 33
437	437	contendere to Medicaid fraud as described in this subchapter shall pay one 34
438	438	(1) of the following fines assessed under this subchapter : 35
439	439	(1) If no monetary loss overpayment is incurred by the Arkansas 36 SB518
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443	443
444	444	Medicaid Program, a fine of not less than one thousand dollars ($1,000) or 1
445	445	more than three thousand dollars ($3,000) for each omission or fraudulent act 2
446	446	or claim violation of Medicaid fraud, § 5 -55-111; or 3
447	447	(2) If a monetary loss an overpayment is incurred by the 4
448	448	Arkansas Medicaid Program, a fine of an amount not less than the amount of 5
449	449	the monetary loss to overpayment made by the Arkansas Medicaid Program and 6
450	450	not more than three (3) times two (2) times the amount of the monetary loss 7
451	451	to overpayment made by the Arkansas Medicaid Program. 8
452	452	(b)(1) The fines described in subdivision (a)(2) of this sectio n may 9
453	453	be waived by the prosecuting attorney. 10
454	454	(2) If the fines are waived, the trier of fact may impose fines 11
455	455	under § 5-4-201. 12
456	456	(c)(1) All fines assessed under subsection (a) of this section shall 13
457	457	be credited to the general revenues of the State of Arka nsas paid to the 14
458	458	Attorney General's office and disbursed in accordance with the rules of the 15
459	459	Arkansas Medicaid Program with the state's share being deposited into the 16
460	460	Arkansas Medicaid Trust Fund . 17
461	461	(2) All other fines assessed by the court in an action b rought 18
462	462	under this subchapter shall be credited to the general revenues of the State 19
463	463	of Arkansas. 20
464	464	21
465	465	SECTION 11. Arkansas Code § 5 -55-110 and § 5-55-111 are amended to 22
466	466	read as follows: 23
467	467	5-55-110. Suspension Exclusion of violators. 24
468	468	The Secretary of the Department of Human Services may suspend or revoke 25
469	469	the provider agreement between the Department of Human Services and a person 26
470	470	in the event the person is found guilty of violating a provision of this 27
471	471	subchapter. 28
472	472	(a) Upon conviction for a violation of thi s subchapter, the Secretary 29
473	473	of the Department of Human Services or the Secretary of the Department of 30
474	474	Inspector General may exclude a person or Medicaid provider from 31
475	475	participation in the Arkansas Medicaid Program and terminate the Medicaid 32
476	476	provider number and provider agreement. 33
477	477	(b) The exclusion or termination process shall be conducted in 34
478	478	accordance with rules of the Arkansas Medicaid Program. 35
479	479	36 SB518
480	480
481	481	13 3/28/2023 4:19:57 PM JMB439
482	482
483	483
484	484	5-55-111. Criminal acts constituting Medicaid fraud. 1
485	485	A person commits Medicaid fraud when he or she: 2
486	486	(1) Purposely makes or causes to be made any omission or 3
487	487	material false statement, omission, or representation of a material fact in 4
488	488	any claim, bill, invoice, census, request for payment, or application for any 5
489	489	benefit or other communication seeking payment under the Arkansas Medicaid 6
490	490	Program; 7
491	491	(2) At any time purposely Purposely makes or causes to be made 8
492	492	any omission or material false statement, omission, or representation of a 9
493	493	material fact in an application for eligibility or in required documentatio n 10
494	494	for use in determining rights to a benefit or payment under the Arkansas 11
495	495	Medicaid Program; 12
496	496	(3) Having knowledge of the occurrence of any event affecting 13
497	497	his or her a Medicaid recipient's or a Medicaid provider's initial or 14
498	498	continued right to any benef it or payment under the Arkansas Medicaid 15
499	499	Program, or the initial or continued right to any benefit or payment under 16
500	500	the Arkansas Medicaid Program of any other individual in Medicaid recipient 17
501	501	on whose behalf he or she a Medicaid provider has applied for or is receiving 18
502	502	the benefit or payment under the Arkansas Medicaid Program, purposely 19
503	503	conceals or fails to disclose the event with an intent fraudulently to secure 20
504	504	a purpose to secure fraudulently the benefit or payment under the Arkansas 21
505	505	Medicaid Program either in a greater amount or quantity than is due or when 22
506	506	no benefit or payment under the Arkansas Medicaid Program is authorized; 23
507	507	(4) Having made or submitted a claim, request for payment, or 24
508	508	application to receive any benefit or payment under the Arka nsas Medicaid 25
509	509	Program for the use and benefit of another person and having received it, 26
510	510	purposely converts the benefit or payment under the Arkansas Medicaid Program 27
511	511	or any part of the benefit or payment under the Arkansas Medicaid Program to 28
512	512	a use other than for the use and benefit of the other person; 29
513	513	(5) Purposely presents or causes to be presented a claim for a 30
514	514	service required to be provided by a person with a particular type of license 31
515	515	or credential while knowing that the individual who furnished t he service was 32
516	516	not licensed or credentialed; 33
517	517	(6) Purposely solicits or receives any remuneration, including 34
518	518	any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, 35
519	519	in cash or in kind: 36 SB518
520	520
521	521	14 3/28/2023 4:19:57 PM JMB439
522	522
523	523
524	524	(A) In return for referring an individual to a person for 1
525	525	the furnishing or arranging for the furnishing of any item or service for 2
526	526	which payment may be made in whole or in part under the Arkansas Medicaid 3
527	527	Program; or 4
528	528	(B) In return for purchasing, leasing, ordering, or 5
529	529	arranging for or recommend ing purchasing, leasing, or ordering any good, 6
530	530	facility, service, or item for which payment may be made in whole or in part 7
531	531	under the Arkansas Medicaid Program; 8
532	532	(7)(A) Purposely offers or pays any remuneration, including any 9
533	533	kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in 10
534	534	cash or in kind, to any person to induce that person to: 11
535	535	(i) Refer an individual to a person for the 12
536	536	furnishing or arranging for the furnishing of any item or service for which 13
537	537	payment may be made in who le or in part under the Arkansas Medicaid Program; 14
538	538	or 15
539	539	(ii) Purchase, lease, order, or arrange for or 16
540	540	recommend purchasing, leasing, or ordering any good, facility, service, or 17
541	541	item for which payment may be made in whole or in part under the Arkansas 18
542	542	Medicaid Program. 19
543	543	(B) If the transaction is otherwise legal and properly 20
544	544	documented as occurring in the normal course of business, subdivisions 21
545	545	(7)(A)(i) and (ii) of this section do not apply to: 22
546	546	(i) A discount or other reduction in price obtained 23
547	547	by a provider of services or other entity under the Arkansas Medicaid Program 24
548	548	if the reduction in price is properly disclosed and appropriately reflected 25
549	549	in the costs claimed or charges made by the provider or entity under the 26
550	550	Arkansas Medicaid Program; 27
551	551	(ii) Any amount paid by an employer to an employee 28
552	552	who has a bona fide employment relationship with the employer for employment 29
553	553	in the provision of covered items or services; 30
554	554	(iii) Any amount paid by a vendor of goods or 31
555	555	services to a person authorize d to act as a purchasing agent for a group of 32
556	556	individuals or entities who are furnishing services reimbursed under the 33
557	557	Arkansas Medicaid Program if: 34
558	558	(a) The person has a written contract with 35
559	559	each individual or entity that specifies the amount to be paid to the person 36 SB518
560	560
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562	562
563	563
564	564	and the amount may be a fixed amount or a fixed percentage of the value of 1
565	565	the purchases made by each individual or entity under the co ntract; and 2
566	566	(b) In the case of an entity that is a 3
567	567	provider of services as defined in § 20 -9-101, the person discloses in such 4
568	568	form and manner as the Secretary of the Department of Human Services requires 5
569	569	to the entity and, upon request, to the secre tary, the amount received from 6
570	570	each vendor with respect to purchases made by or on behalf of the entity; or 7
571	571	(iv) Any payment practice specified by the secretary 8
572	572	promulgated pursuant to applicable federal or state law; 9
573	573	(8)(6) Purposely makes or cause s to be made, or induces or seeks 10
574	574	to induce, any omission or material false statement, omission, or 11
575	575	representation of a material fact with respect to the conditions or operation 12
576	576	of any institution, facility, or Medicaid provider in order that the 13
577	577	institution, facility, or Medicaid provider may qualify to obtain or maintain 14
578	578	any licensure or certification when the licensure or certification is 15
579	579	required to be enrolled or eligible to deliver any healthcare goods or 16
580	580	services to Medicaid recipients by state law, federal law, or the rules of 17
581	581	the Arkansas Medicaid Program; 18
582	582	(9)(7) Purposely: 19
583	583	(A) Charges a Medicaid recipient or any person acting on 20
584	584	behalf of a Medicaid recipient , for any service provided to a patient under 21
585	585	the Arkansas Medicaid Program, money or other consideration for any 22
586	586	healthcare goods or services provided to a Medicaid recipient under the 23
587	587	Arkansas Medicaid Program at a rate in excess of the rates established by the 24
588	588	state Arkansas Medicaid Program ; or 25
589	589	(B) Charges, solicits, accepts, or r eceives, in addition 26
590	590	to any amount otherwise required to be paid under the Arkansas Medicaid 27
591	591	Program, any gift, money, donation, or other consideration other than a 28
592	592	charitable, religious, or philanthropic contribution from an organization or 29
593	593	from a person unrelated to the patient: 30
594	594	(i) As a precondition of admitting a patient to a 31
595	595	hospital, nursing facility, or intermediate care facility for individuals 32
596	596	with intellectual disabilities; or 33
597	597	(ii) As a requirement for the patient's continued 34
598	598	stay in a hospital, nursing facility, or intermediate care facility for 35
599	599	individuals with intellectual disabilities when the cost of the services 36 SB518
600	600
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602	602
603	603
604	604	provided in the hospital, nursing facility, or intermediate care facility for 1
605	605	individuals with intellectual disabilities to the patient is paid for in 2
606	606	whole or in part under the Arkansas Medicaid Program; or 3
607	607	(C) Charges a Medicaid recipient who is receiving 4
608	608	healthcare goods or services from a managed care organization or other form 5
609	609	of capitated rate program in any amount o r method not authorized by the rules 6
610	610	of the Arkansas Medicaid Program or a contract with the Medicaid provider; 7
611	611	(10)(8) Purposely makes or causes to be made any material false 8
612	612	statement, omission, or representation of a material fact in any application 9
613	613	for a benefit or payment in violation of the rules and provider agreements 10
614	614	issued by the Arkansas Medicaid Program or its fiscal agents; 11
615	615	(11) Knowingly submits false documentation or makes or causes to 12
616	616	be made or induces or seeks to induce any material false statement to the 13
617	617	Office of Medicaid Inspector General or the Medicaid Fraud Control Unit 14
618	618	within the office of the Attorney General during an audit or in response to a 15
619	619	request for information or a subpoena; 16
620	620	(12)(9) Purposely alters, forges, or utters a forged the 17
621	621	signature of a doctor, nurse, or other medical professional on a 18
622	622	prescription, referral for healthcare goods or services, or finding of 19
623	623	medical necessity for any Medicaid recipient of the Arkansas Medicaid 20
624	624	Program; 21
625	625	(13) Knowingly submits a forged prescription, referral for 22
626	626	healthcare goods or services, or finding of medical necessity for: 23
627	627	(A) Payment under the Arkansas Medicaid Program; or 24
628	628	(B) An audit or in response to a request for information 25
629	629	or a subpoena to the Office of Medic aid Inspector General or the Medicaid 26
630	630	Fraud Control Unit within the office of the Attorney General; or 27
631	631	(14)(10) Purposely places a false entry makes or causes to be 28
632	632	made any material false statement, omission, or representation of fact in a 29
633	633	medical chart, medical record, or any record of services required to be made 30
634	634	to the Arkansas Medicaid Program that indicates that healthcare goods or 31
635	635	services have been provided to a Medicaid recipient knowing that the 32
636	636	healthcare goods or services we re not provided; 33
637	637	(11) Purposely makes or causes to be made any material false 34
638	638	statement, omission, or representation of a fact in any unit rate development 35
639	639	process, actuarial process, reconciliation process, cost report, disclosure 36 SB518
640	640
641	641	17 3/28/2023 4:19:57 PM JMB439
642	642
643	643
644	644	form, or documentatio n required under the Arkansas Medicaid Program; or 1
645	645	(12)(A) Having knowledge or having discovered that an improper, 2
646	646	inadvertent, or accidental overpayment has been made by the Arkansas Medicaid 3
647	647	Program, purposely fails to promptly report and repay the ov erpayment. 4
648	648	(B) It is a defense to a prosecution under subdivision 5
649	649	(12)(A) of this section that the overpayment was reported and repayment was 6
650	650	made within ninety (90) days of discovery . 7
651	651	8
652	652	SECTION 12. Arkansas Code Title 5, Chapter 55, Subchapter 1, is 9
653	653	amended to add an additional section to read as follows: 10
654	654	5-55-112. Kickbacks and other unlawful remuneration, referral fees, 11
655	655	bonuses, bribes, or rebates. 12
656	656	(a) It is unlawful to solicit or receive any payment or other 13
657	657	compensation, including any kickback , bribe, rebate, or referral fee, 14
658	658	directly or indirectly, overtly or covertly, in cash or in kind: 15
659	659	(1) In return for referring an individual to a person for the 16
660	660	furnishing or arranging for the furnishing of any item or service for which 17
661	661	payment may be made in whole or in part under the Arkansas Medicaid Program; 18
662	662	or 19
663	663	(2) In return for purchasing, leasing, ordering, or arranging 20
664	664	for or recommending purchasing, leasing, or ordering any goods, facility, 21
665	665	service, or item for which payment may be made in who le or in part under the 22
666	666	Arkansas Medicaid Program. 23
667	667	(b) It is unlawful to offer or pay any payment or compensation, 24
668	668	including any kickback, bribe, rebate, or referral fee, directly or 25
669	669	indirectly, overtly or covertly, in cash or in kind, to any person to i nduce 26
670	670	that person to: 27
671	671	(1) Refer an individual to a person for the furnishing or 28
672	672	arranging for the furnishing of any item or service for which payment may be 29
673	673	made in whole or in part under the Arkansas Medicaid Program; or 30
674	674	(2) Purchase, lease, order, or arrange for or recommend 31
675	675	purchasing, leasing, or ordering any goods, facility, service, or item for 32
676	676	which payment may be made in whole or in part under the Arkansas Medicaid 33
677	677	Program. 34
678	678	(c) If the transaction is otherwise legal and properly documented as 35
679	679	occurring in the normal course of business, subdivisions (b)(1) and (2) of 36 SB518
680	680
681	681	18 3/28/2023 4:19:57 PM JMB439
682	682
683	683
684	684	this section do not apply to: 1
685	685	(1) A discount or other reduction in price obtained by a 2
686	686	provider of services or other entity under the Arkansas Medicaid Program if 3
687	687	the reduction in price is properly disclosed and appropriately reflected in 4
688	688	the costs claimed or charges made by the provider or entity under the 5
689	689	Arkansas Medicaid Program; 6
690	690	(2) Any amount paid by an employer to an employee who has a bona 7
691	691	fide employment relationship with the employer for employment in the 8
692	692	provision of covered goods or services, except that an employer may not pay 9
693	693	an employee a signing bonus, referral fee, or other payments for a new client 10
694	694	or patient that the employee provided covered goods or service s to at a prior 11
695	695	place of employment during the preceding twelve (12) months; 12
696	696	(3) Any amount paid by a vendor of goods or services to a person 13
697	697	authorized to act as a purchasing agent for a group of individuals or 14
698	698	entities who are furnishing services reim bursed under the Arkansas Medicaid 15
699	699	Program if: 16
700	700	(A) The person has a written contract with each individual 17
701	701	or entity that specifies the amount to be paid to the person and the amount 18
702	702	may be a fixed amount or a fixed percentage of the value of the purcha ses 19
703	703	made by each individual or entity under the contract; and 20
704	704	(B) In the case of an entity that is a provider of 21
705	705	services as defined in § 20 -9-101, the person discloses on a form and in a 22
706	706	manner as the Secretary of the Department of Human Services requ ires to the 23
707	707	entity and, upon request, to the secretary, the amount received from each 24
708	708	vendor with respect to purchases made by or on behalf of the entity. 25
709	709	(d)(1)(A) A violation under this section is a Class D felony if the 26
710	710	aggregate amount of the unlawfu l compensation paid or received in violation 27
711	711	of this section is one thousand dollars ($1,000) or more but less than two 28
712	712	thousand five hundred dollars ($2,500). 29
713	713	(B) A violation under this section is a Class A 30
714	714	misdemeanor if the aggregate amount of the u nlawful compensation paid or 31
715	715	received in violation of this section is less than one thousand dollars 32
716	716	($1,000). 33
717	717	(2) A violation under this section is a Class C felony if the 34
718	718	aggregate amount of the unlawful compensation paid or received in violation 35
719	719	of this section is two thousand five hundred dollars ($2,500) or more but 36 SB518
720	720
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722	722
723	723
724	724	less than five thousand dollars ($5,000). 1
725	725	(3) A violation under this section is a Class B felony if the 2
726	726	aggregate amount of the unlawful compensation paid or received in violation 3
727	727	of this section is five thousand dollars ($5,000) or more but less than 4
728	728	twenty-five thousand dollars ($25,000). 5
729	729	(4) A violation under this section is a Class A felony if the 6
730	730	aggregate amount of the unlawful compensation paid or received in violation 7
731	731	of this section is twenty-five thousand dollars ($25,000) or more. 8
732	732	(e) Restitution ordered for a violation of this section is limited to 9
733	733	the actual loss to the Arkansas Medicaid Program that resulted directly or 10
734	734	indirectly from the unlawful payment or compensa tion. 11
735	735	(f)(1) Upon conviction for a violation of this section and in addition 12
736	736	to any other fine authorized for the offense, the court shall impose a fine 13
737	737	of not less than the unlawful payment or compensation paid or received or 14
738	738	more than two (2) times the unlawful payment or compensation paid or 15
739	739	received. 16
740	740	(2) All other fines assessed under this section shall be paid to 17
741	741	the Attorney General's office and disbursed in accordance with rules of the 18
742	742	Arkansas Medicaid Program with the state’s share being deposited into the 19
743	743	Arkansas Medicaid Program Trust Fund. 20
744	744	21
745	745	SECTION 13. Arkansas Code § 5 -55-113(e), concerning rewards for 22
746	746	information within the Medicaid Fraud Act, is amended to read as follows: 23
747	747	(e)(1) The Attorney General may agree to a payment of up to ten 24
748	748	percent (10%) of the civil penalty funds collected at the time of the 25
749	749	conviction not to exceed ten thousand dollars ($10,000) as a reward in any 26
750	750	settlement agreement case under this section. 27
751	751	(2) A portion of restitution shall not be used as a re ward The 28
752	752	reward authorized by subdivision (e)(1) of this section shall not reduce the 29
753	753	restitution owed. 30
754	754	31
755	755	SECTION 14. Arkansas Code § 5 -55-114(c)-(e), concerning a special 32
756	756	deputy prosecutor within the Medicaid Fraud Act, is amended to read as 33
757	757	follows: 34
758	758	(c) With the approval of the prosecuting attorney, a special deputy 35
759	759	prosecutor under this section may also use a prosecutor investigative 36 SB518
760	760
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762	762
763	763
764	764	subpoena as provided in § 16 -43-212. 1
765	765	(d) A special deputy prosecutor appointed and functioning as 2
766	766	authorized under this section is entitled to the same immunity granted by law 3
767	767	to the prosecuting attorney. 4
768	768	(d)(1)(e)(1) Appointment as a special deputy prosecutor does not 5
769	769	enable the attorney to receive any additional fees or salary from the state 6
770	770	for services provided pur suant to the appointment. 7
771	771	(2) Expenses of the special deputy prosecutor and any fees and 8
772	772	costs incurred by the special deputy prosecutor in the prosecution of cases 9
773	773	as provided in this section are the responsibility of the Attorney General. 10
774	774	(e)(f) The prosecuting attorney may revoke the appointment of a 11
775	775	special deputy prosecutor at any time. 12
776	776	13
777	777	SECTION 15. Arkansas Code § 5 -55-115 is amended to read as follows: 14
778	778	5-55-115. Suspension, exclusion, and illegal unlawful Medicaid 15
779	779	participation. 16
780	780	(a)(1) It is unlawful for a suspended or excluded individual person or 17
781	781	organization to participate in the Arkansas Medicaid Program under federal 18
782	782	and state laws. 19
783	783	(2) A violation of subdivision (a)(1) of this section is a Class 20
784	784	C felony. 21
785	785	(b)(1) A person commits illegal Medicaid participation if: 22
786	786	(A) Having been suspended from the Arkansas Medicaid 23
787	787	Program or placed on a state or federal excluded Medicaid provider list, the 24
788	788	person knowingly participates, directly or indirectly, in the Arkansas 25
789	789	Medicaid Program; or 26
790	790	(B) As a certified health provider enrolled in the 27
791	791	Arkansas Medicaid Program pursuant to Title XIX of the Social Security Act, 28
792	792	as amended, 42 U.S.C. § 1396 et seq., or as the fiscal agent of the certified 29
793	793	health provider, the person employs, or en gages as an independent contractor, 30
794	794	or engages as a consultant, or otherwise permits the participation in the 31
795	795	business activities of the certified health provider, any person who has 32
796	796	pleaded guilty or nolo contendere to or has been found guilty of a charge of 33
797	797	Medicaid fraud, theft of public benefits, § 5 -36-202, or abuse of adults, § 34
798	798	5-28-101 et seq. 35
799	799	(2) Illegal Medicaid participation is a Class A misdemeanor. 36 SB518
800	800
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802	802
803	803
804	804	(b)(1) A person commits unlawful Medicaid participation if the person 1
805	805	knowingly allows or per mits a suspended or excluded person or organization to 2
806	806	participate directly or indirectly in the Arkansas Medicaid Program. 3
807	807	(2) Unlawful Medicaid participation is a Class A misdemeanor. 4
808	808	5
809	809	SECTION 16. Arkansas Code Title 5, Chapter 55, Subchapter 1, is 6
810	810	amended to add an additional section to read as follows: 7
811	811	5-55-116. Obstructing a Medicaid review, audit, investigation, or 8
812	812	prosecution. 9
813	813	(a) A person commits the offense of obstructing a Medicaid review, 10
814	814	audit, investigation, or prosecution if the perso n: 11
815	815	(1) Purposely makes a material false statement or omission or 12
816	816	causes another person to make a material false statement or omission to an 13
817	817	auditor or investigator with the Office of the Medicaid Inspector General, or 14
818	818	the Medicaid Fraud Control Unit, or in response to a request for information 15
819	819	or subpoena; 16
820	820	(2) Purposely submits or causes another person to submit false, 17
821	821	fabricated, forged, or altered documentation to the Office of the Medicaid 18
822	822	Inspector General or the Medicaid Fraud Control Unit, witho ut regard to 19
823	823	whether the documentation is provided in response to a verbal request, 20
824	824	written request for information, or a subpoena; or 21
825	825	(3) Purposely destroys or alters any record with the purpose to 22
826	826	conceal a false or fraudulent claim made to the Arkansas Medicaid Program or 23
827	827	to interfere with an ongoing review, audit, investigation, or prosecution 24
828	828	being conducted by the Office of the Medicaid Inspector General or the 25
829	829	Medicaid Fraud Control Unit. 26
830	830	(b)(1) Obstructing a Medicaid review, audit, invest igation, or 27
831	831	prosecution is a Class B felony if the conduct interferes with an audit, 28
832	832	investigation, or prosecution related to any felony offense. 29
833	833	(2) Otherwise, obstructing a Medicaid review, audit, 30
834	834	investigation, or prosecution is a Class A misdemeanor . 31
835	835	32
836	836	SECTION 17. Arkansas Code § 20 -77-901(7), concerning the definition of 33
837	837	"material" within the Medicaid Fraud False Claims Act, is amended to read as 34
838	838	follows: 35
839	839	(7)(A) “Material” means having a natural tendency to influence, 36 SB518
840	840
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842	842
843	843
844	844	or be capable of influencin g, the payment or receipt of money or property . 1
845	845	(B) A false statement, omission, or representation is 2
846	846	material if the false statement, omission, or representation is likely to 3
847	847	induce or cause the Arkansas Medicaid Program to pay, approve, or act in a 4
848	848	particular way; 5
849	849	6
850	850	SECTION 18. Arkansas Code § 20 -77-901(11) and (12), concerning the 7
851	851	definitions within the Medicaid Fraud False Claims Act, is amended to read as 8
852	852	follows: 9
853	853	(11) "Overpayment" means the full amount of the Medicaid funds 10
854	854	obtained as a direct or indirect result of a violation of § 5 -55-111, § 20-11
855	855	77-902, the rules of the Arkansas Medicaid Program, or a managed care 12
856	856	provider contract; 13
857	857	(12) “Person” means any: 14
858	858	(A) Medicaid provider of goods or services or any 15
859	859	employee, independent contra ctor, or subcontractor of the Medicaid provider, 16
860	860	whether that provider be an individual, individual medical vendor, firm, 17
861	861	corporation, professional association, partnership, organization, risk -based 18
862	862	provider organization, managed care organization, or othe r legal entity; or 19
863	863	(B) Individual, individual medical vendor, firm, 20
864	864	corporation, professional association, partnership, organization, risk -based 21
865	865	provider organization, managed care organization, or other legal entity, or 22
866	866	any employee of any individual, individual medical vendor, firm, corporation, 23
867	867	professional association, partnership, organization, risk -based provider 24
868	868	organization, managed care organization, or other legal entity, not a 25
869	869	Medicaid provider under the Arkansas Medicaid Program but that pro vides goods 26
870	870	or services to a Medicaid provider under the Arkansas Medicaid Program for 27
871	871	which the Medicaid provider submits claims to the Arkansas Medicaid Program 28
872	872	or its fiscal agents; and 29
873	873	(12)(A)(13) “Records” means all documents in any form that 30
874	874	disclose the nature, extent, and level of healthcare goods and services 31
875	875	provided to Medicaid recipients ., including without limitation: 32
876	876	(A) Images, slides, film, video, and similar physical and 33
877	877	digital files resulting from common diagnostic testing such as 34
878	878	(B) “Records” include X-rays, magnetic resonance imaging 35
879	879	scans, computed tomography scans, computed axial tomography scans, 36 SB518
880	880
881	881	23 3/28/2023 4:19:57 PM JMB439
882	882
883	883
884	884	ultrasounds, and other diagnostic imaging commonly used and retained as part 1
885	885	of the medical records of a patient tools; 2
886	886	(B) Records documenting treatment administration, 3
887	887	medication administration, and activities of daily living; and 4
888	888	(C) All financial reports, cost reports, disclosure forms, 5
889	889	and other Medicaid records submitted or required to be retained in any rate 6
890	890	development or review process, reconciliation process, or actuarial process 7
891	891	required by the rules of Arkansas Medicaid Program or state law; and 8
892	892	(14)(A) “Unlawful Medicaid participation” means participation in 9
893	893	the Arkansas Medicaid Program when the individual o r organization is 10
894	894	suspended from the Arkansas Medicaid Program or on a state or federal 11
895	895	excluded Medicaid provider list. 12
896	896	(B) “Unlawful Medicaid participation” includes without 13
897	897	limitation when a suspended or excluded individual or organization: 14
898	898	(i) Is employed or contracting with a Medicaid 15
899	899	provider or managed care organization or otherwise associated with a Medicaid 16
900	900	provider or managed care organization for the purpose of providing or 17
901	901	supervising the provision of goods and services to Medicaid reci pients; 18
902	902	(ii) Plays any role in the management of a Medicaid 19
903	903	provider directly as a manager or management company or indirectly as a 20
904	904	consultant or advisor; or 21
905	905	(iii) Receives payment for administrative and 22
906	906	management services directly or indirectly related to patient care such as 23
907	907	processing Medicaid claims for payment, attending to services that assist or 24
908	908	support Medicaid recipients, or acting as a Medicaid consultant or advisor . 25
909	909	26
910	910	SECTION 19. Arkansas Code §§ 20 -77-902 and 20-77-903 are amended to 27
911	911	read as follows: 28
912	912	20-77-902. Liability for certain acts. 29
913	913	(a) A person shall be liable to the State of Arkansas, through the 30
914	914	Attorney General, for restitution, damages, and a civil penalty for an act or 31
915	915	omission in violation of this subchapter if he or sh e: 32
916	916	(1) Knowingly makes or causes to be made any material false 33
917	917	statement, omission, or representation of a material fact in any claim, bill, 34
918	918	invoice, request for payment, or application for any benefit or other 35
919	919	communication seeking payment under the Ar kansas Medicaid Program; 36 SB518
920	920
921	921	24 3/28/2023 4:19:57 PM JMB439
922	922
923	923
924	924	(2) Knowingly makes or causes to be made any material omission 1
925	925	or false statement, omission, or representation of a material fact in an 2
926	926	application for eligibility or in required documentation for use in 3
927	927	determining rights the right to a benefit or payment under the Arkansas 4
928	928	Medicaid Program; 5
929	929	(3) Having knowledge of the occurrence of any event affecting 6
930	930	his or her a Medicaid recipient's or a Medicaid provider's initial or 7
931	931	continued right to any benefit or payment or the initial or continued right 8
932	932	to any benefit or payment under the Arkansas Medicaid Program of any other 9
933	933	individual in Medicaid recipient on whose behalf he or she a Medicaid 10
934	934	provider has applied for or is receiving a benefit or payment under the 11
935	935	Arkansas Medicaid Program , knowingly conceals or fails to disclose that event 12
936	936	with an intent fraudulently to secure a purpose to secure fraudulently the 13
937	937	benefit or payment under the Arkansas Medicaid Program either in a greater 14
938	938	amount or quantity than is due or when no benefit or payment under the 15
939	939	Arkansas Medicaid Program is authorized; 16
940	940	(4) Having made or submitted a claim, request for payment, or 17
941	941	application to receive any benefit or payment under the Arkansas Medicaid 18
942	942	Program for the use and benefit of another person and having received it, 19
943	943	knowingly converts the benefit or payment under the Arkansas Medicaid Program 20
944	944	or any part of the benefit or payment under the Arkansas Medicaid Program to 21
945	945	a use other than for the use and benefit of the other person; 22
946	946	(5) Knowingly presents or causes to be presented a claim for a 23
947	947	physician's service for which payment may be made under the program and knows 24
948	948	that the individual who furnished the service was not license d as a physician 25
949	949	service required to be provided by a person with a particular type of license 26
950	950	or credential while knowing that the individual who furnished the service was 27
951	951	not licensed or credentialed ; 28
952	952	(6) Knowingly solicits or receives any remuneration payment or 29
953	953	other compensation, including any kickback, bribe, or rebate, or referral 30
954	954	fee, directly or indirectly, overtly or covertly, in cash or in kind: 31
955	955	(A) In return for referring an individual to a person for 32
956	956	the furnishing or arranging for the f urnishing of any item or service for 33
957	957	which payment may be made in whole or in part under the program Arkansas 34
958	958	Medicaid Program; or 35
959	959	(B) In return for purchasing, leasing, ordering, or 36 SB518
960	960
961	961	25 3/28/2023 4:19:57 PM JMB439
962	962
963	963
964	964	arranging for or recommending purchasing, leasing, or ordering any go od, 1
965	965	facility, service, or item for which payment may be made in whole or in part 2
966	966	under the program Arkansas Medicaid Program ; 3
967	967	(7)(A) Knowingly offers or pays any remuneration payment or 4
968	968	other compensation, including any kickback, bribe, or rebate, or referral 5
969	969	fee, directly or indirectly, overtly or covertly, in cash or in kind to any 6
970	970	person to induce the person to: 7
971	971	(i) Refer an individual to a person for the 8
972	972	furnishing or arranging for the furnishing of any item or service for which 9
973	973	payment may be made in whole or in part under the program Arkansas Medicaid 10
974	974	Program; or 11
975	975	(ii) Purchase, lease, order, or arrange for or 12
976	976	recommend purchasing, leasing, or ordering any good, facility, service, or 13
977	977	item for which payment may be made in whole or in part u nder the program 14
978	978	Arkansas Medicaid Program . 15
979	979	(B) If the transaction is otherwise legal and properly 16
980	980	documented as occurring in the normal course of business, subdivision (7)(A) 17
981	981	of this section does not apply to: 18
982	982	(i) A discount or other reduction in price obtained 19
983	983	by a provider of services or other entity under the program Arkansas Medicaid 20
984	984	Program if the reduction in price is properly disclosed and appropriately 21
985	985	reflected in the costs claimed or charges made by the provider or entity 22
986	986	under the program Arkansas Medicaid Program ; 23
987	987	(ii) Any amount paid by an employer to an employee 24
988	988	who has a bona fide employment relationship with the employer for employment 25
989	989	in the providing of covered items or services , except that an employer may 26
990	990	not pay an employee a signing bonus, referral fee, or other payments for a 27
991	991	new client or patient the employee previously provided covered goods or 28
992	992	services to at a prior place of employment during the preceding twelve (12) 29
993	993	months; or 30
994	994	(iii) Any salary, wages, or commiss ion amount paid 31
995	995	during the normal course of business by a vendor of goods or services to a 32
996	996	person authorized to act as a purchasing agent for a group of individuals or 33
997	997	entities that are furnishing services reimbursed under the program Arkansas 34
998	998	Medicaid Program, if: 35
999	999	(a) The person has a written contract with 36 SB518
1000	1000
1001	1001	26 3/28/2023 4:19:57 PM JMB439
1002	1002
1003	1003
1004	1004	each individual or entity that specifies the amount to be paid to the person, 1
1005	1005	which amount may be a fixed amount or a fixed percentage of the value of the 2
1006	1006	purchases made by each individual or entit y under the contract; and 3
1007	1007	(b) In the case of an entity that is a 4
1008	1008	Medicaid provider as defined in § 20 -77-901, the person discloses, in the 5
1009	1009	form and manner as the Secretary of the Department of Human Services 6
1010	1010	requires, to the entity and upon request t o the secretary the amount received 7
1011	1011	from each vendor with respect to purchases made by or on behalf of the 8
1012	1012	entity; or 9
1013	1013	(iv) Any other payment practice specified by the 10
1014	1014	secretary promulgated pursuant to applicable federal or state law; 11
1015	1015	(8) Knowingly makes or causes to be made or induces or seeks to 12
1016	1016	induce any material omission or false statement, omission, or representation 13
1017	1017	of a material fact with respect to the conditions or operation of any 14
1018	1018	institution, facility, or Medicaid provider in order that t he institution, 15
1019	1019	facility, or Medicaid provider may qualify to obtain or maintain any 16
1020	1020	licensure or certification when the licensure or certification is required to 17
1021	1021	be enrolled or eligible to deliver any healthcare goods or services to 18
1022	1022	Medicaid recipients by state law, federal law, or the rules of the program 19
1023	1023	Arkansas Medicaid Program ; 20
1024	1024	(9) Knowingly: 21
1025	1025	(A) Charges a Medicaid recipient or any person acting on 22
1026	1026	behalf of a Medicaid recipient money or other consideration for any good or 23
1027	1027	service provided to a patient Medicaid recipient under the program money or 24
1028	1028	other consideration Arkansas Medicaid Program at a rate in excess of the 25
1029	1029	rates established by the state Arkansas Medicaid Program ; or 26
1030	1030	(B) Charges, solicits, accepts, or receives, in addition 27
1031	1031	to any amount otherwise required to be paid under the program Arkansas 28
1032	1032	Medicaid Program, any gift, money, donation, or other consideration other 29
1033	1033	than a charitable, religious, or philanthropic contribution from an 30
1034	1034	organization or from a person unrelated to the pa tient: 31
1035	1035	(i) As a precondition of admitting a patient to a 32
1036	1036	hospital, nursing facility, or intermediate care facility for individuals 33
1037	1037	with intellectual disabilities; or 34
1038	1038	(ii) As a requirement for the patient's continued 35
1039	1039	stay in the hospital, nursing f acility, or intermediate care facility for 36 SB518
1040	1040
1041	1041	27 3/28/2023 4:19:57 PM JMB439
1042	1042
1043	1043
1044	1044	individuals with intellectual disabilities when the cost of the services 1
1045	1045	provided therein at the hospital, nursing facility, or intermediate care 2
1046	1046	facility for individuals with intellectual disabilities to the patient is 3
1047	1047	paid for in whole or in part under the program Arkansas Medicaid Program ; or 4
1048	1048	(C) Charges a Medicaid recipient who is receiving goods or 5
1049	1049	services from a managed care organization or other form of capitated rate 6
1050	1050	program in any amount or method not authorized by the rules of the Arkansas 7
1051	1051	Medicaid Program or a contract with a Medicaid provider; 8
1052	1052	(10) Knowingly makes or causes to be made any material omission 9
1053	1053	or false statement, omission, or representation of a material fact in any 10
1054	1054	application for benefits or for a benefit or payment in violation of the 11
1055	1055	rules, regulations, and provider agreements issued by the program Arkansas 12
1056	1056	Medicaid Program or its fiscal agents; 13
1057	1057	(11) Knowingly: 14
1058	1058	(A) Participates, directly or indirectly, in the Arkansas 15
1059	1059	Medicaid Program after having pleaded guilty or nolo contendere to or been 16
1060	1060	found guilty of a charge of Medicaid fraud, theft of public benefits, or 17
1061	1061	abuse of adults as defined in the Arkansas Criminal Code, § 5 -1-101 et seq.; 18
1062	1062	or 19
1063	1063	(B) As a certified health pro vider enrolled in the program 20
1064	1064	pursuant to Title XIX of the Social Security Act or as the fiscal agent of 21
1065	1065	such a provider who employs, engages as an independent contractor, engages as 22
1066	1066	a consultant, or otherwise permits the participation in the business 23
1067	1067	activities of such a provider, any person who has pleaded guilty or nolo 24
1068	1068	contendere to or has been found guilty of a charge of Medicaid fraud, theft 25
1069	1069	of public benefits, or abuse of adults as defined in the Arkansas Criminal 26
1070	1070	Code, § 5-1-101 et seq.; 27
1071	1071	(12)(11) Knowingly submits any false documentation supporting a 28
1072	1072	claim or prior payment to the Office of Medicaid Inspector General or the 29
1073	1073	Medicaid Fraud Control Unit within the office of the Attorney General during 30
1074	1074	an investigation or audit or in response to a req uest for information or a 31
1075	1075	subpoena; 32
1076	1076	(13)(12) Knowingly makes or causes to be made, or induces or 33
1077	1077	seeks to induce, any material false statement to the Office of Medicaid 34
1078	1078	Inspector General or the Medicaid Fraud Control Unit within the office of the 35
1079	1079	Attorney General Attorney General's office during an investigation or audit 36 SB518
1080	1080
1081	1081	28 3/28/2023 4:19:57 PM JMB439
1082	1082
1083	1083
1084	1084	or in response to a request for information or a subpoena; 1
1085	1085	(14)(13) Knowingly alters, forges, or utters a forged the 2
1086	1086	signature of a doctor or nurse on a prescription, or referral for healthcare 3
1087	1087	goods or services, or submits a forged prescription or referral for 4
1088	1088	healthcare goods or services in support of a claim for payment under the 5
1089	1089	program a finding of medical necessity for a Medicaid recipient ; 6
1090	1090	(15)(14) Knowingly places a false entry makes or causes to be 7
1091	1091	made any material false statement, omission, or representation of a fact in a 8
1092	1092	medical chart, or medical record, or record that indicates that healthcare 9
1093	1093	goods or services have been provided to a Medicaid recipient kn owing that the 10
1094	1094	healthcare goods or services were not provided; 11
1095	1095	(15)(A) Knowing or having discovered that an improper, 12
1096	1096	inadvertent, or accidental overpayment has been made by the Arkansas Medicaid 13
1097	1097	Program, a Medicaid provider fails to promptly report and repay the 14
1098	1098	overpayment. 15
1099	1099	(B) It is a defense to prosecution under this section that 16
1100	1100	the overpayment was reported and repayment was made within ninety (90) days 17
1101	1101	of discovery; 18
1102	1102	(16) Knowingly commits or permits another person or an 19
1103	1103	organization to commit unlawful Medicaid participation as defined by § 20 -77-20
1104	1104	901(14); 21
1105	1105	(16)(17) Knowingly presents, or causes to be presented, a false 22
1106	1106	or fraudulent claim for payment or approval to the program Arkansas Medicaid 23
1107	1107	Program; 24
1108	1108	(17)(18) Knowingly makes, uses, or causes to be made or used a 25
1109	1109	false record or statement that is material to a false or fraudulent claim to 26
1110	1110	the program Arkansas Medicaid Program ; 27
1111	1111	(18)(19) Knowingly: 28
1112	1112	(A) Makes, uses, or causes to be made or used a false 29
1113	1113	record or statement that is material to an obligation to pay or transmit 30
1114	1114	money or property to the program Arkansas Medicaid Program ; or 31
1115	1115	(B) Conceals or improperly avoids or decreases an 32
1116	1116	obligation to pay or transmit money or property to the program Arkansas 33
1117	1117	Medicaid Program; 34
1118	1118	(19) Conspires to commit a violation of this section; or 35
1119	1119	(20) Knowingly presents or causes to be presented a claim for a 36 SB518
1120	1120
1121	1121	29 3/28/2023 4:19:57 PM JMB439
1122	1122
1123	1123
1124	1124	service required to be provided by a person with a particula r type of license 1
1125	1125	or credential while knowing that the individual who furnished the service was 2
1126	1126	not licensed or credentialed 3
1127	1127	(20) Purposely makes or causes to be made any material false 4
1128	1128	statement, omission, or representation of a fact in any unit rate d evelopment 5
1129	1129	process, actuarial process, reconciliation process, cost report, disclosure 6
1130	1130	form, or any other documentation required under the Arkansas Medicaid 7
1131	1131	Program; or 8
1132	1132	(21) Conspires to commit a violation of this section . 9
1133	1133	(b) Every person who directl y or indirectly controls another person 10
1134	1134	who is in violation of or liable under this subchapter and every partner, 11
1135	1135	officer, or director of a person who is in violation of or liable under this 12
1136	1136	subchapter shall be jointly and severally liable for any penaltie s assessed 13
1137	1137	and any monetary judgments awarded in any proceeding for civil enforcement of 14
1138	1138	the provisions of this subchapter if the persons to be held jointly and 15
1139	1139	severally liable knew or should have known of the existence of the facts by 16
1140	1140	reason of which the violation or liability exists. 17
1141	1141	18
1142	1142	20-77-903. Restitution, damages, and civil penalties. 19
1143	1143	(a)(1) It shall be unlawful for any person to commit any act 20
1144	1144	prohibited by § 20-77-902, and any person found to have committed any such 21
1145	1145	act or acts shall be liable to the State of Arkansas through the Attorney 22
1146	1146	General. 23
1147	1147	(2) In a case in which direct monetary loss does not exist or in 24
1148	1148	which it is difficult or impossible to determine the extent of the loss, the 25
1149	1149	Attorney General may elect to seek a civil penalty based o n the number of 26
1150	1150	fraudulent claims submitted or other violations of this subchapter . 27
1151	1151	(3) The state shall make an election and give notice in the 28
1152	1152	complaint whether the state is seeking a civil penalty of: 29
1153	1153	(A) Not less than five hundred dollars ($500) but not more 30
1154	1154	than ten thousand dollars ($10,000) for each false claim or other violation 31
1155	1155	of § 20-77-902; or 32
1156	1156	(B) Two (2) times the amount of overpayment and damages 33
1157	1157	that the state and the Arkansas Medicaid Program sustained because of the act 34
1158	1158	of the person false claim or other violation of § 20 -77-902. 35
1159	1159	(b) When a person or Medicaid provider discovers an employee or 36 SB518
1160	1160
1161	1161	30 3/28/2023 4:19:57 PM JMB439
1162	1162
1163	1163
1164	1164	subcontractor working for the person or Medicaid provider has committed a 1
1165	1165	violation of this subchapter or a violation under the Medicaid Fr aud Act, § 2
1166	1166	5-55-101 et seq., the person or Medicaid provider can avoid any statutory 3
1167	1167	liability for civil penalties under subdivision (a)(3)(B) of this section may 4
1168	1168	be reduced by fifty percent (50%) if a person or Medicaid provider can 5
1169	1169	establish all of the f ollowing: 6
1170	1170	(1) The employer or contractor of the person or Medicaid 7
1171	1171	provider committing the violation of this subchapter furnished officials of 8
1172	1172	the Attorney General's office Medicaid Fraud Control Unit with all 9
1173	1173	information known to the person or Medicaid provider employer or contractor 10
1174	1174	about the violation within thirty (30) sixty (60) days after the date on 11
1175	1175	which the person or Medicaid provider employer or contractor first obtained 12
1176	1176	the information; and 13
1177	1177	(2) The employer or contractor of the person or Medicaid 14
1178	1178	provider committing the violation of this subchapter fully cooperated with 15
1179	1179	any Attorney General's investigation of the violation , and at the time the 16
1180	1180	person or Medicaid provider furnished the Attorney General with the 17
1181	1181	information about the violation:; and 18
1182	1182	(A)(3) No At the time of the report, an audit, 19
1183	1183	investigation, criminal prosecution, civil action, or administrative action 20
1184	1184	had not commenced under this subchapter with respect to the violation ; and 21
1185	1185	(B) The person or Medicaid pro vider did not have actual 22
1186	1186	knowledge of the existence of an investigation into the violation . 23
1187	1187	(c) If the reporting employer or contractor was negligent in its 24
1188	1188	supervision, without regarding to subdivision (b) of this section, the 25
1189	1189	employer or contractor ma y be required to pay a single penalty under 26
1190	1190	subdivision (a)(3)(A) of this section. 27
1191	1191	(c)(1)(d) In addition to any other penalties authorized herein under 28
1192	1192	this section, any person violating this subchapter shall also be liable to 29
1193	1193	the State of Arkansas for : 30
1194	1194	(1) Restitution of an overpayment by the Arkansas Medicaid 31
1195	1195	Program, which shall be paid to the Department of Human Services and 32
1196	1196	deposited into the Arkansas Medicaid Program Trust Fund for the loss to the 33
1197	1197	Arkansas Medicaid Program or its fiscal agents; a nd 34
1198	1198	(2) The the Attorney General's reasonable expenses, including 35
1199	1199	the cost of investigation, attorney's fees, court costs, witness fees, and 36 SB518
1200	1200
1201	1201	31 3/28/2023 4:19:57 PM JMB439
1202	1202
1203	1203
1204	1204	deposition fees, which shall be paid to the Attorney General's office to be 1
1205	1205	used for future Medicaid investigatio ns and cases. 2
1206	1206	(2) Any cost or reimbursement ordered under this subsection 3
1207	1207	shall be paid to the office of the Attorney General to be used for future 4
1208	1208	Medicaid investigations and cases. 5
1209	1209	(d)(1)(e)(1) When the loss is to the Arkansas Medicaid Program or it s 6
1210	1210	fiscal agents, the entirety of any penalty obtained under subsection (a) of 7
1211	1211	this section less reimbursement of investigation and prosecution costs and 8
1212	1212	any reward that may be determined by the court pursuant to under this 9
1213	1213	subchapter shall be credited as s pecial revenues of the State of Arkansas and 10
1214	1214	deposited into the Arkansas Medicaid Program Trust Fund for the sole use of 11
1215	1215	the program Arkansas Medicaid Program . 12
1216	1216	(2) When the loss is to a managed care organization or similar 13
1217	1217	organization that is paid at a capitated rate, the Department of Human 14
1218	1218	Services may return all or a portion of the funds to a managed care 15
1219	1219	organization or any similar organization when permitted by the contract or 16
1220	1220	rules. 17
1221	1221	(e)(1)(f)(1) A person who engages or has engaged in any act des cribed 18
1222	1222	by § 20-77-902 may be enjoined in a court of competent jurisdiction in an 19
1223	1223	action brought by the Attorney General. 20
1224	1224	(2) An injunction described by subdivision (e)(1) (f)(1) of this 21
1225	1225	section shall be: 22
1226	1226	(A) Brought in the name of the state; and 23
1227	1227	(B) Granted if a case is clearly shown that the rights of 24
1228	1228	the state are being violated by the person and the state will would suffer 25
1229	1229	immediate and irreparable injury, loss, or damage pending a final judgment in 26
1230	1230	the action or that the acts or omissions of the person will tend to render a 27
1231	1231	final judgment ineffectual. 28
1232	1232	(f)(g) The court may make orders or judgments, including the 29
1233	1233	appointment of a receiver, as necessary to: 30
1234	1234	(1) Prevent any act described by § 20 -77-902 by any person; or 31
1235	1235	(2) Restore to the program any money or property, real or 32
1236	1236	personal, that may have been acquired by means of an act described by § 20 -33
1237	1237	77-902. 34
1238	1238	35
1239	1239	SECTION 20. Arkansas Code § 20 -77-904, concerning investigations by 36 SB518
1240	1240
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1242	1242
1243	1243
1244	1244	the Attorney General within the Medicaid Fraud False Claims Act , is amended 1
1245	1245	to add an additional subsection to read as follows: 2
1246	1246	(f)(1) A Medicaid program provider shall cooperate in reviews, audits, 3
1247	1247	and investigations conducted by the Department of Human Services, Office of 4
1248	1248	the Medicaid Inspector General, and the Me dicaid Fraud Control Unit. 5
1249	1249	(2) A request for information includes formal and informal 6
1250	1250	requests made to a Medicaid provider by any attorney, auditor, officer, or 7
1251	1251	agent of the Office of the Medicaid Inspector General or the Medicaid Fraud 8
1252	1252	Control Unit. 9
1253	1253	10
1254	1254	SECTION 21. Arkansas Code § 20 -77-908(c) and (d), concerning the false 11
1255	1255	claims jurisdiction and the procedures within the Medicaid Fraud False Claims 12
1256	1256	Act, are amended to read as follows: 13
1257	1257	(c) If the offense referenced in subsection (a) of this section is not 14
1258	1258	discovered by the Medicaid Fraud Control Unit or an aggrieved party who has a 15
1259	1259	legal duty to refer the action to the Medicaid Fraud Control Unit during the 16
1260	1260	period stated in subsection (b) of this section, the State of Arkansas may 17
1261	1261	bring a civil action u nder this subchapter on behalf of the Arkansas Medicaid 18
1262	1262	Program within one (1) year after the offense is discovered by the parties. 19
1263	1263	(d) In any action brought pursuant to this subchapter, the State of 20
1264	1264	Arkansas shall be required to prove all essential elements of the cause of 21
1265	1265	action, including damages, by a preponderance of the evidence. 22
1266	1266	(d)(e)(1) A subpoena requiring the production of d ocuments or the 23
1267	1267	attendance of a witness at an interview, trial, or hearing conducted under 24
1268	1268	this section may be served by the Attorney General or any duly authorized law 25
1269	1269	enforcement officer in the State of Arkansas personally, telephonically, or 26
1270	1270	by registered or certified mail. 27
1271	1271	(2) In the case of service by registered or certified mail, the 28
1272	1272	return shall be accompanied by the return post office receipt of delivery of 29
1273	1273	the demand. 30
1274	1274	31
1275	1275	SECTION 22. Arkansas Code § 20 -77-910 is amended to read as follows: 32
1276	1276	20-77-910. Suspension of violators. 33
1277	1277	The Secretary of the Department of Human Services may suspend exclude a 34
1278	1278	Medicaid provider or revoke the provider agreement between an individual and 35
1279	1279	the Department of Human Services and the person in the event that the pers on 36 SB518
1280	1280
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1282	1282
1283	1283
1284	1284	is found guilty of or a Medicaid provider for violating the terms of this 1
1285	1285	subchapter. 2
1286	1286	3
1287	1287	SECTION 23. Arkansas Code § 20 -77-911(e)-(g), concerning rewards for 4
1288	1288	persons providing information regarding false Medicaid claims within the 5
1289	1289	Medicaid Fraud False C laims Act, is amended to read as follows: 6
1290	1290	(e)(1) The Attorney General may agree to a payment of up to ten 7
1291	1291	percent (10%) of the civil penalty total funds collected at the time of the 8
1292	1292	settlement not to exceed ten thousand dollars ($10,000) as a reward in any 9
1293	1293	settlement agreement under this section . 10
1294	1294	(2) The reward authorized under subdivision (e)(1) of this 11
1295	1295	section shall not reduce the restitution owed. 12
1296	1296	(f) A portion of restitution shall not be used as a reward. 13
1297	1297	(g)(1)(f)(1) The General Assembly finds that: 14
1298	1298	(A) Medicaid is a joint federal and state program, with 15
1299	1299	each claim normally involving both state and federal funds; 16
1300	1300	(B) The United States Congress has granted jurisdiction to 17
1301	1301	federal district courts over any actio n brought under the laws of any state 18
1302	1302	for the recovery of funds paid by a state or local government if the action 19
1303	1303	arises from the same transaction or occurrence as an action brought under 31 20
1304	1304	U.S.C. § 3730; 21
1305	1305	(C) The General Assembly does not intend to gr ant a 22
1306	1306	general right of action to private parties in state or federal court; and 23
1307	1307	(D) This section authorizes a limited right to bring false 24
1308	1308	claims and other ancillary state claims in federal court under 31 U.S.C. § 25
1309	1309	3730, to recover the Medicaid funds su bject to recovery under 31 U.S.C. § 26
1310	1310	3730 and associated penalties and costs; and 27
1311	1311	(D)(E) As federal law has granted federal courts with 28
1312	1312	jurisdiction to hear claims involving state funds associated with the 29
1313	1313	Arkansas Medicaid Program, the Attorney General shall be given notice and the 30
1314	1314	opportunity to intervene or to otherwise protect the interest of this state 31
1315	1315	any time a party brings an action attempting to recover funds from the 32
1316	1316	Arkansas Medicaid Program under 31 U.S.C. § 3730 . 33
1317	1317	(2)(A) Any party bringing a claim in federal court to recover 34
1318	1318	state funds associated with the Arkansas Medicaid Program or pursuant to an 35
1319	1319	assertion of a state claim under state law shall serve the Attorney General 36 SB518
1320	1320
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1322	1322
1323	1323
1324	1324	through the Medicaid Fraud Control Unit with any complaint, any oth er 1
1325	1325	pleadings, and the written disclosure of all material evidence and 2
1326	1326	information possessed by the person bringing the action. 3
1327	1327	(B) The complaint, pleadings, and disclosed information 4
1328	1328	shall be filed under seal pursuant to federal law and shall remain un der seal 5
1329	1329	until the seal is lifted in accordance with federal law. 6
1330	1330	(3)(A) The Attorney General may investigate the claim and, if 7
1331	1331	appropriate, intervene or otherwise litigate and pursue any claim brought in 8
1332	1332	any litigation in federal court to recover state funds associated with claims 9
1333	1333	paid by the Arkansas Medicaid Program in actions brought under the federal 10
1334	1334	False Claims Act, 31 U.S.C. § 3729 et seq. 11
1335	1335	(B) The Attorney General may also seek related damages, 12
1336	1336	civil penalties, and costs, and to litigate or s ettle said claims as 13
1337	1337	permitted or required under state and federal law. 14
1338	1338	(4)(A) If the state is properly served and given notice as 15
1339	1339	required in this subsection by a party bringing an action under the federal 16
1340	1340	False Claims Act to recover state funds of the Arkansas Medicaid Program , the 17
1341	1341	Attorney General may pay agree to an order or settlement that funds the 18
1342	1342	reward authorized under federal law , if the state's share of funds for the 19
1343	1343	Arkansas Medicaid Program is collected and the Arkansas Medicaid Program is 20
1344	1344	made whole from collected penalties . 21
1345	1345	(B) However, under no circumstances may any reward be paid 22
1346	1346	from the state funds owed to the Arkansas Medicaid Program. 23
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1348	1348	25
1349	1349	26
1350	1350	27
1351	1351	28
1352	1352	29
1353	1353	30
1354	1354	31
1355	1355	32
1356	1356	33
1357	1357	34
1358	1358	35
1359	1359	36