The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 507 Engrossed 2018 Regular Session Mills
Proposed law provides that a Medicaid managed care organization shall be liable to a provider for
payment of claims to the provider when the provider followed instructions of the managed care
organization to his detriment and did not act with fault or fraudulent intent regarding enrollment,
credentialing, or accreditation.
Proposed law provides that a Medicaid managed care organization shall be liable to the state for any
payment to providers when the provider acts with fault or fraudulent intent regarding enrollment,
credentialing, or accreditation. Proposed law provides that failure to execute the provisions of their
responsibility to mitigate fraud and waste is not considered a risk of the Managed care organization.
Proposed law provides that the Medicaid managed care organization is not precluded from recouping
and retaining improper payments and overpayments to a provider after the state has been reimbursed.
Proposed law requires the managed care organization to cover the expense of reimbursement to the
provider or to the state from the administrative funding allocated to the managed care organization.
Proposed law requires the Louisiana Department of Health to impose penalties on the Medicaid
managed care plan for the infractions established in proposed law in accordance with rules and
regulations promulgated pursuant to the Administrative Procedure Act.
Proposed law requires each Medicaid managed care organization to report every instance of fraud,
waste, or abuse to the Louisiana Department of Health and the attorney general.
Proposed law gives the attorney general authority to investigate, enforce, impose sanctions upon, and
seek recoupment from the Medicaid managed care plans. Proposed law returns recoupments to the
Louisiana Department of Health and deposits all other monies received from the Medicaid managed
care organizations into the Medical Assistance Programs Fraud Detection Fund.
Proposed law provides that nothing in proposed law prevents the Louisiana Department of Health
or the attorney general from enforcing and imposing penalties otherwise provided for in law or
regulation.
Effective August 1, 2018.
(Adds R.S. 46:460.72)
Summary of Amendments Adopted by Senate Committee Amendments Proposed by Senate Committee on Health and Welfare to the
original bill
1. Provides that failure to execute the provisions of the managed care organization's
contractual responsibility to mitigate fraud and waste is not considered a risk of the
managed care organization.
2. Provides that the Medicaid managed care organization is not precluded from
recouping and retaining improper payments and overpayments to a provider after the
state has been reimbursed.
3. Requires each Medicaid managed care organization to report every instance of fraud,
waste, or abuse to the Louisiana Department of Health and the attorney general.
4. Clarifies that among the attorney general's enforcement authority is the ability to
impose penalties, civil monetary penalties, and additional recoveries or costs of
investigations.
5. Clarifies that the Louisiana Department of Health or the attorney general shall not be
precluded from enforcing and imposing penalties otherwise provided for in law or
regulation.
6. Replaces "monetary sanctions" with "penalties".
7. Removes the word "irrefutably" from the burden of proof provision regarding false
information submitted by the provider to the managed care organization.