DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 258 Original 2016 Regular Session Mike Johnson
Abstract: Adds grounds and procedures for denial or revocation of Medicaid provider agreements
pursuant to the Medical Assistance Programs Integrity Law.
Present law known as the Medical Assistance Programs Integrity Law provides grounds for denial
or revocation of agreements between healthcare providers and the Department of Health and
Hospitals, referred to hereafter as the "department", for provision of services to Medicaid enrollees.
Proposed law retains present law, and adds thereto violating or entering into a settlement agreement
under the provisions of present law and proposed law, the Federal False Claims Act, the Federal
Civil Monetary Penalties Act, or any other similar statutes pertaining to fraud as grounds for denial
or revocation of a Medicaid provider agreement.
Proposed law provides that if a False Claims Act action or other similar action is brought by a qui
tam plaintiff or relator, no violation of proposed law has occurred until the defendant has been found
liable in the action, either by final judgment or by entering into a settlement agreement which
requires the defendant to pay any sum as damages to the relator in the qui tam action and to the
federal government or any state government who contends in the settlement agreement that the
defendant submitted false claims or made false statements in connection with claims submitted under
any of the following programs:
(1)The Medicaid program or any other publicly funded medical assistance program.
(2)Any federal block grant program.
Proposed law provides that no violation of proposed law has occurred if, at minimum, five years
have passed from the time a person is found liable or entered a settlement agreement under the False
Claims Act, or other similar civil statute, and the conditions of the judgment or settlement have been
satisfactorily fulfilled.
Proposed law requires the department to promulgate emergency rules requiring an immediate review
of all active Medicaid provider agreements. Requires further that all Medicaid providers disclose
to the department any and all documentation pertaining to any grounds for provider agreement
revocation provided in present law and proposed law relative to conduct by the healthcare provider,
his agent, a managing employee, provider-in-fact, affiliate, or any person having an ownership
interest equal to 5% or greater in the healthcare provider. Provides that the emergency rules required
by proposed law shall require such documentation from providers upon initial application for enrollment, as well as upon renewal, or at any time requested by the department.
Proposed law requires that any healthcare provider seeking a license to operate in a facility that is
maintained, owned, or operated by its affiliate healthcare provider enrolled as a Medicaid provider
shall first disclose to the department whether the enrolled provider to which it is an affiliate is
subject to being held in violation of present law or proposed law pertaining to fraud or false claims
submitted by the enrolled provider under a state or federal medical assistance program.
Proposed law provides that if an applicant provider discloses to the department that the applicant
provider, his agent, a managing employee, provider-in-fact, affiliate, or any person having an
ownership interest equal to 5% or greater in the healthcare provider is subject to being considered
in violation of present law or proposed law pertaining to fraud or false claims submitted to any
publicly funded medical assistance program or any federal block grant program, then the applicant
provider shall be considered ineligible to obtain a license to establish or operate a healthcare facility
in this state.
Proposed law provides that the ineligibility of a provider for a license pursuant to proposed law does
not depend on imposition by the department of prior or future sanctions on the provider, his agent,
a managing employee, provider-in-fact, affiliate, or any person having an ownership interest equal
to 5% or greater in the healthcare provider.
Proposed law provides that if at least five years have passed from the time a provider initially
became subject to being considered in violation of present law or proposed law pertaining to fraud
or false claims, then the provider shall be eligible to apply for a license.
(Amends R.S. 46:437.14(A)(intro. para.) and (12); Adds R.S. 46:437.3(31) and 437.14(A)(13), (C),
and (D))