Basic due process for health care providers under Medicaid investigation would be protected under a bill reported by the Assembly Committee on Health earlier this week. The bill, which has bi-partisan support from 66 Assembly Members, now heads to the Assembly Committee on Codes. The bill is sponsored in the Senate by Senator Craig M. Johnson and is currently in the Senate Health Committee.

“To crack down on Medicaid fraud, I helped write the law that set up the Office of the Medicaid Inspector General (OMIG), the False Claims Act to encourage whistleblowers, and the criminal law to make it easier to prosecute Medicaid fraud,” said Assembly Member Richard N. Gottfried, Chair of the Assembly Health Committee and sponsor of A.10360-B. “OMIG is catching a lot of bad guys and recovering hundreds of millions. But it’s also grabbing many innocent health care providers and accusing them of ‘fraud and abuse’ for simple clerical errors or legitimate disagreements about medical necessity.”

Key provisions of the bill would change current practices by requiring:

• Health care providers would be entitled to a hearing before being required to pay back Medicaid funds.
• If a service was provided in proper compliance with Medicaid rules at the time, those rules could not be changed retroactively to deny payment.
• Mathematically valid statistic sampling methodology be used when “extrapolating” to invalidate claims OMIG has not looked at.
• Technical or administrative errors in a Medicaid claim would be penalized, even if the service had been properly provided, but Medicaid would not take back the full amount paid for the service.

“This bill simply provides the principles our legal system is based on: requiring that you be awarded basic rights if the government accuses you of doing something wrong,” Gottfried added.

For more information on the four additional bills passed by the Assembly Health Committee, please contact the sponsor listed after the description below.

Protecting Sexual Assault Victims – Provides for hospitals to offer prophylaxis drug treatment for victims of sexual assault who may have been exposed to HIV, with financial assistance from the Crime Victims Board. (A.2355-A, Jaffee)

Preventing the Spread of HIV – To discourage illegal drug users from sharing needles and spreading HIV and other diseases, New York allows over-the-counter sale of hypodermics. This bill would allow a person to buy more than 10 and allow pharmacies to advertise the availability of hypodermics. (A.10880, Gottfried)

Safe Staffing for Quality Care Act – Enacts nurse staffing and reporting standards for hospitals and nursing homes, to increase patient safety and quality of care. (A.11015, Gottfried)

Legal Aid for Patients – Authorizes grants for “health-related legal services programs” for income-eligible patients and their families to resolve legal matters that have an impact on patient health. The programs would be run by legal services organizations in cooperation with hospitals and other health facilities. (A.11030, Gottfried)