Medicaid reform bill would create new fraud inspector


LITTLE ROCK — Legislation aimed at rooting out Medicaid fraud would establish an office of Medicaid Inspector General and provide testing of Medicaid claims.

Those proposed provisions were added in an amendment Monday to Senate Bill 914, which originally filed in shell form. The amended measure is before the Senate Committee on State Agencies and Governmental Affairs. The sponsors are Sen. David Sanders, R-Little Rock and Rep. Bruce Westerman, R-Hot Springs.

The Medicaid Inspector General would be part of the governor’s office under the bill. The head of the office would be a gubernatorial appointee, confirmed by the state Senate and would serve at the will of the governor.

The bill stipulates that the director “shall have not less than 10 years of professional experience” in prosecution for fraud, fraud investigation, auditing or “comparable alternate experience in health care, if the health care experience involves some consideration of fraud.”

The new officer would be authorized to hire a staff to investigate suspected Medicaid fraud and abuse, working in conjunction with the attorney general’s Medicaid Fraud Control Unit as well as U.S. attorneys and state prosecutors.

Creation of the new office would mean consolidating the staff and “other Medicaid fraud detection, prevention and recovery functions from the relevant governmental entities into a single office.”

SB 914 also would create new criminal offense of health care fraud and direct the Office of Information Technology to test and strengthen the Medicaid payment system to detect fraud, improve accountability and automate processes for the review of claims.

The measure calls for an annual report on health insurance fraud , to be submitted on or before March 1 by the state insurance commissioner.

Republican legislators have pushed for reform of the current Medicaid program this session as Gov. Mike Beebe and legislative leaders attempt to hammer out a deal to use federal dollars to subsidize health insurance for Arkansas’ working poor through the state’s health exchange as an alternative to expanding the Medicaid program.