ENROLLED
ACT No. 420
2017 Regular Session
HOUSE BILL NO. 459
BY REPRESENTATIVES BACALA AND HOFFMANN
1 AN ACT
2 To amend and reenact R.S. 46:440.1(E)(2) and to enact Subpart D-1 of Part VI-A of Chapter
3 3 of Title 46 of the Louisiana Revised Statutes of 1950, to be comprised of R.S.
4 46:440.4 through 440.8, relative to Medicaid fraud detection and prevention; to
5 create a task force on coordination of Medicaid fraud detection and prevention
6 initiatives; to provide for the membership, purposes, and duties of the task force; to
7 authorize appropriation of monies in the Medical Assistance Programs Fraud
8 Detection Fund for activities of the task force; to provide for a termination date; and
9 to provide for related matters.
10 Be it enacted by the Legislature of Louisiana:
11 Section 1. R.S. 46:440.1(E)(2) and Subpart D-1 of Part VI-A of Chapter 3 of Title
12 46 of the Louisiana Revised Statutes of 1950, comprised of R.S. 46:440.4 through 440.8, are
13 hereby enacted to read as follows:
14 §440.1. Medical Assistance Programs Fraud Detection Fund
15 * * *
16 E. The monies in the fund shall not be used to replace, displace, or supplant
17 state general funds appropriated for the daily operation of the department or the
18 medical assistance programs and may be appropriated by the legislature for the
19 following purposes only:
20 * * *
21 (2) To enhance fraud and abuse detection and prevention activities related
22 to the medical assistance programs, including the activities of the task force on
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1 coordination of Medicaid fraud detection and prevention initiatives established
2 pursuant to Subpart D-1 of this Part.
3 * * *
4 SUBPART D-1. COORDINATION OF FRAUD AND ABUSE
5 DETECTION AND PREVENTION INITIATIVES
6 §440.4. Legislative findings; purpose
7 A. The legislature hereby finds and declares all of the following:
8 (1) Cost containment in the medical assistance program operated pursuant
9 to Title XIX of the Social Security Act, referred to hereafter in this Subpart as
10 "Medicaid", is an urgent priority of this state.
11 (2) It is the policy of this state to combat and prevent fraud and abuse
12 committed by any healthcare provider participating in the Medicaid program and by
13 any other persons including Medicaid enrollees, and to negate the adverse effects of
14 Medicaid fraud and abuse on the fiscal integrity and public health of this state.
15 B. The purpose of this Subpart is to create an interagency task force to
16 coordinate existing Medicaid fraud detection and prevention efforts and to
17 recommend means for enhancing the efficacy of those efforts.
18 §440.5. Task force on coordination of Medicaid fraud detection and prevention
19 initiatives; creation; membership
20 A. There is hereby created within the office of the legislative auditor a task
21 force on coordination of Medicaid fraud detection and prevention initiatives, referred
22 to hereafter in this Subpart as the "task force".
23 B. The task force shall be composed of the following members:
24 (1) The governor or his designee.
25 (2) The attorney general or his designee.
26 (3) The legislative auditor or his designee.
27 (4) The inspector general or his designee.
28 (5) One member of the House of Representatives appointed by the speaker
29 of the House of Representatives.
30 (6) One member of the Senate appointed by the president of the Senate.
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1 (7) The secretary of the Louisiana Department of Health or his designee.
2 C. The task force shall include the following nonvoting advisory members
3 who, upon request of the task force chairman, shall cooperate with and assist in the
4 efforts of the task force:
5 (1) One advisory member appointed by the secretary of the Louisiana
6 Department of Health.
7 (2) One advisory member appointed by the secretary of the Department of
8 Revenue.
9 (3) One advisory member appointed by the governor who represents the
10 medical field.
11 (4) One advisory member appointed by the governor who represents the
12 dental field.
13 D. At the first meeting of the task force, the members of the task force shall
14 select one eligible member to serve as chairman. Any member except a legislator
15 shall be eligible to serve as chairman of the task force.
16 E.(1) The task force shall adopt rules of procedure and any other policies as
17 may be necessary to facilitate the work of the group.
18 (2) The task force may form subcommittees for examination of special topics
19 and issues within the overall subject matter of Medicaid fraud detection and
20 prevention.
21 §440.6. Purposes of the task force
22 The purposes of the task force shall include the following:
23 (1) To study and evaluate on an ongoing basis the laws, rules, policies, and
24 processes by which the state implements Medicaid fraud detection and prevention
25 efforts.
26 (2) To identify and recommend opportunities for improving coordination of
27 Medicaid fraud detection and prevention initiatives across state agencies and
28 branches of state government.
29 (3) To identify any systemic or systemwide issues of concern within the
30 Medicaid program with respect to fraud, waste, and abuse.
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1 (4) To develop recommendations for policies and procedures by which to
2 facilitate and implement all of the following:
3 (a) Random sampling of Medicaid cases to be selected for verification of
4 enrollee eligibility.
5 (b) Improvements in the Medicaid program integrity functions of the
6 Louisiana Department of Health.
7 (c)(i) Optimization of data mining among state-owned data sets for purposes
8 of Medicaid fraud detection and prevention.
9 (ii) For purposes of this Subparagraph, "data mining" means the practice of
10 electronically sorting data through statistical modeling, intelligent technologies, and
11 other methods in order to uncover patterns, relationships, and other indicators of
12 actual or potential Medicaid fraud, waste, or abuse.
13 (5) To make reports to the governor and to the legislature in accordance with
14 R.S. 46:440.7.
15 §440.7. Reporting
16 A. On or before January 1, 2018, and semiannually thereafter, the task force
17 shall prepare and submit to the governor and the legislature a report concerning the
18 status of Medicaid fraud detection and prevention initiatives and the status of efforts
19 to coordinate such initiatives across state agencies and branches of state government.
20 B. At minimum, the report required by this Section shall include
21 information, analysis, and commentary related to each purpose of the task force
22 enumerated in R.S. 46:440.6, and may include any other information as the task
23 force deems necessary or appropriate.
24 §440.8. Termination
25 The provisions of this Subpart shall terminate on August 1, 2018.
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1 Section 2. The legislative auditor shall take such actions as are necessary to ensure
2 that the task force on coordination of Medicaid fraud detection and prevention initiatives
3 created by the provisions of Section 1 of this Act convenes on or before September 1, 2017.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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