Bill Text: IN SB0559 | 2013 | Regular Session | Amended
Bill Title: Fraud.
Spectrum: Partisan Bill (Republican 5-0)
Status: (Passed) 2013-05-13 - Public Law 197 [SB0559 Detail]
Download: Indiana-2013-SB0559-Amended.html
Citations Affected: IC 6-8.1; IC 7.1-2; IC 12-7; IC 12-13; IC 12-15;
IC 20-26.
Effective: July 1, 2013.
January 14, 2013, read first time and referred to Committee on Health and Provider
Services.
January 31, 2013, amended; reassigned to Committee on Tax and Fiscal Policy.
February 21, 2013, amended, reported favorably _ Do Pass.
Digest Continued
the application for or receipt of Medicaid assistance. Requires a transportation provider that applies to enroll in the Medicaid program to file with the office of Medicaid policy and planning a surety bond to be used for specified purposes. Provides certain exceptions. Requires the office of Medicaid policy and planning to visit certain Medicaid providers and provider applicants if certain conditions are met. Requires a national criminal history background check on certain Medicaid provider applicants at the cost of the applicant. Allows an audit and inspection of completed school lunch program applications to ensure that applicants meet the requirements to participate in the program.
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or
A BILL FOR AN ACT to amend the Indiana Code concerning
fraud.
(b) All agencies of the state of Indiana shall cooperate with the department in the administration of the listed taxes and shall, upon request and at no charge to the department, furnish to the department any information relevant to the administration and collection of the listed taxes that the department requests. In addition, a state agency that encounters the use of a fraudulent identity shall notify the department and provide in electronic format identifying information as specified by the department for the department's use in preventing tax fraud. If a state agency encounters the use of
fraudulent identities on a regular basis, the state agency shall
provide to the department a monthly electronic report furnishing
the identifying information specified by the department.
(c) Before December 1 each year:
(1) the department of correction shall provide to the
department an electronic file listing the name and Social
Security number of each individual under the jurisdiction of
the department of correction as of November 1 of that year;
and
(2) the state department of health shall provide to the
department an electronic file listing the name of each
individual for whom an Indiana death certificate was issued
during the immediately preceding twelve (12) months.
(b) "Person", for purposes of IC 12-13-14, has the meaning set forth in IC 12-13-14-1.
(c) "Person", for purposes of IC 12-17.2, means an individual who is at least twenty-one (21) years of age, a corporation, a partnership, a voluntary association, or other entity.
(d) "Person", for purposes of IC 12-15-2-20, means an individual who is:
(1) at least twenty-one (21) years of age; and
(2) applying for or receiving Medicaid assistance.
(1) Applicants.
(2) Recipients.
(3) Retailers that participate in the EBT program.
(4) Individuals who sell or purchase access to cash assistance
benefits in violation of any federal or state law or regulation.
(b) The division shall establish a process for a recipient to follow in order to receive a replacement EBT card. The process must include contact with the division's local office for replacement if the individual requesting replacement of the EBT card has previously requested a replacement EBT card at least four (4) times in the preceding twelve (12) month period.
(c) The division may deny replacement of an EBT card if the recipient seeking replacement of the EBT card does not follow the procedure established by the division under subsection (b).
(1) the provider is categorized as high risk to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450; and
(2) the provider's Medicaid claims have increased by at least fifty percent (50%) over a six (6) month period.
(b) The office shall adopt rules under IC 4-22-2 or issue a Medicaid provider bulletin setting forth procedures and standards for the visit required under this section.
(1) One (1) year if the conviction is for the person's first offense.
(2) Two (2) years if the conviction is for the person's second offense.
(3) Ten (10) years
(b) A person's ineligibility period for Medicaid assistance described in subsection (a) begins either:
(1) on the date the person is sentenced, if the person's sentence does not include incarceration; or
(2) on the date the individual is released from incarceration.
(c) Upon receipt of substantiated evidence that a person has committed fraud concerning the application for or receipt of Medicaid assistance, the office may remove the person from receiving Medicaid assistance for one (1) year. If the office determines that a person receiving Medicaid assistance is to be removed from receiving Medicaid assistance under this subsection, the person may appeal the determination. An appeal under this subsection is subject to IC 4-21.5.
(d) The office may adopt rules under IC 4-22-2 to implement this section.
(1) that is a common carrier, including a person that provides transportation by a taxi; and
(2) that:
(A) is enrolled; or
(B) applies for enrollment;
in the Medicaid program as a Medicaid provider to render transportation services to Medicaid recipients.
(b) This section does not apply to a transportation provider that is:
(1) exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code;
(2) at the discretion of the secretary, granted a waiver of the bond requirement under subsection (c) to provide transportation services in a federal or state designated underserved area;
(3) at the discretion of the secretary, granted a waiver of the bond requirement under subsection (c) based on the determination that the provider does not pose a significant risk of submitting fraudulent or false Medicaid claims;
(4) owned or controlled by a person that is licensed or certified by a board listed in IC 25-1-9-1;
(5) owned or controlled by a pharmacy that has a permit issued under IC 25-26-13;
(6) owned or controlled by a hospital licensed under IC 16-21; or
(7) required under federal law to obtain a surety bond to cover Medicaid overpayments and false Medicaid claims and has obtained a bond that complies with the applicable federal law.
(c) A transportation provider that applies for enrollment as a Medicaid provider:
(1) as a new applicant;
(2) due to a change in ownership of a transportation provider currently enrolled; or
(3) due to a purchase or transfer of the assets of a transportation provider currently enrolled;
shall, at the time the transportation provider files a provider agreement with the office, submit to the office a surety bond that meets the requirements of subsection (d) and is issued by a surety that is authorized by the office of the secretary.
(d) The following apply to a surety bond filed with the office under this section:
(1) The surety bond must be continuously in effect for at least three (3) years after the application is made as described in subsection (c).
(2) The surety bond must provide coverage for liability of at least fifty thousand dollars ($50,000).
(3) The surety bond must name the:
(A) transportation provider as the principal;
(B) office as the obligee; and
(C) person that issues the surety bond, including the person's heirs, executors, administrators, successors, and assignees, jointly and severally, as surety.
(4) The surety bond must provide the surety's name, street address or post office box number, city, state, and ZIP code.
(5) The surety bond must provide that the surety is liable under the surety bond for a duplicate, erroneous, or false Medicaid claim paid by the office or its fiscal agent to the transportation provider during the term of the surety bond.
(6) The surety bond must provide that the bond may not be void on a first recovery, but that suits may be instituted until the penalty is exhausted.
(7) The surety bond must guarantee that the surety will, not later than thirty (30) days after the surety receives written notice from the office containing sufficient evidence to establish the surety's liability under the surety bond as described in subdivision (5), pay to the office the following
amounts, not to exceed the full amount of the surety bond:
(A) The amount of the duplicate, erroneous, or false claim
that was previously paid by the office or its fiscal agent to
the transportation provider, plus accrued interest.
(B) An assessment imposed under IC 12-15-22 by the office
on the transportation provider.
(8) The surety bond must provide that if the transportation
provider's provider agreement is not renewed or is
terminated, the surety bond submitted by the transportation
provider remains in effect until the last day of the surety bond
coverage period and the surety remains liable for a duplicate,
erroneous, or false claim paid by the office or its fiscal agent
to the transportation provider during the term of the surety
bond.
(9) The surety bond must provide that actions under the
surety bond may be brought by the office or the attorney
general.
(e) The office may revoke or deny a provider agreement for a
transportation provider's failure to comply with this section.
(f) The office may revoke a provider agreement if a
transportation provider cancels a surety bond required by this
section.
(g) The office or its designee may, at any time, require a
transportation provider to demonstrate compliance with this
section.
(h) If:
(1) a surety has paid the office for a liability incurred under
a surety bond under this section; and
(2) the transportation provider is subsequently successful in
appealing the determination of liability;
the office shall, upon completion of the appellate process, refund
the surety or the transportation provider the full amount paid for
the liability.
(1) Include information that the office determines necessary to facilitate carrying out of IC 12-15.
(2) Prohibit the provider from requiring payment from a recipient of Medicaid, except where a copayment is required by law.
(3) For providers categorized as high risk to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR
455.450, require the submission of necessary information,
forms, or consents for the office to obtain a national criminal
history background check through the state police department
under IC 10-13-3-39 of any person who:
(A) holds at least a five percent (5%) ownership interest in
a facility or entity; or
(B) is a member of the board of directors of a nonprofit
facility or entity;
in which the provider applicant plans to provide Medicaid
services under the provider agreement. The provider
applicant is responsible for the cost of the national criminal
history background check.
(b) Before the office may approve a provider agreement, the office shall conduct a pre-enrollment site visit for provider applicants that are designated as moderate or high categorical risks to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450.
(b) The accounts and records shall:
(1) be available for inspection and audit at all times by authorized officials; and
(2) be preserved for at least five (5) years, as the state superintendent may prescribe.
(c) The state superintendent shall conduct or cause to be conducted any audits, inspections, and administrative reviews of completed applications, acts, records, and operations of a school lunch program necessary to do the following:
(1) Determine whether agreements with the governing body and rules under this chapter are being complied with.
(2) Ensure that a school lunch program is effectively administered.
(3) Ensure that participants meet all requirements to
participate in the school lunch program.
