Bill Text: VA HB2015 | 2019 | Regular Session | Chaptered
Bill Title: Fraud prevention; DMAS to expand its existing program.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2019-03-18 - Governor: Acts of Assembly Chapter text (CHAP0422) [HB2015 Detail]
Download: Virginia-2019-HB2015-Chaptered.html
Be it enacted by the General Assembly of Virginia:
1. That §32.1-319.1 of the Code of Virginia is amended and reenacted as follows:
§32.1-319.1. Department to establish pilot program to use data analytics to mitigate risk of improper payments.
A. The Department shall establish conduct a pilot
program using prepayment analytics to develop and
implement means to mitigate the risk of improper payments to
providers of services that are paid through the Department's fee-for-service
delivery system who commit fraud, abuse, or errors. Such program
furnished under the state plan for medical assistance and all applicable
waivers. The pilot program shall include the use of predictive modeling,
provider profiling, trend analysis, and other prepayment analytics to
identify providers and claims with a high likelihood of fraud, abuse, or
error and prevent payments on potentially fraudulent or erroneous claims
from being made until such claims have been validated.
B. The Department may enter into a contract or agreement with
a vendor for the operation of the pilot program to mitigate the
risk of improper payments to providers of services that are paid through the
Department's fee-for-service delivery system furnished under the state
plan for medical assistance and all applicable waivers required by this
section. However, selection of a vendor shall be dependent on the
demonstration of a proof of concept, prior to entering into a contract or
agreement.
2. That the Department of Medical Assistance Services shall report to the Chairmen of the House Committee on Appropriations and the Senate Committee on Finance (i) by August 1, 2019, on the Department's progress in designing and implementing the pilot program established in accordance with the provisions of this act and (ii) by February 1, 2020, on the effectiveness of the pilot program established pursuant to this act in mitigating the risk of improper payments to providers.
