S T A T E   O F   N E W   Y O R K
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                                  2609

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 26, 2011
                               ___________

Introduced  by  Sen.  KRUGER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Finance

AN ACT to amend the executive  law,  in  relation  to  establishing  the
  office of Empire Blue Cross and Blue Shield inspector general

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The executive law is amended by adding a new section 75  to
read as follows:
  S  75.  EMPIRE BLUE CROSS AND BLUE SHIELD INSPECTOR GENERAL. 1.  DEFI-
NITIONS. FOR THE PURPOSES OF THIS  SECTION,  THE  FOLLOWING  DEFINITIONS
SHALL APPLY:
  A.  "INSPECTOR"  MEANS THE EMPIRE BLUE CROSS AND BLUE SHIELD INSPECTOR
GENERAL CREATED BY THIS SECTION.
  B. "INVESTIGATION" MEANS, INVESTIGATIONS OF FRAUD, ABUSE,  OR  ILLEGAL
ACTS PERPETRATED WITHIN EMPIRE BLUE CROSS AND BLUE SHIELD.
  C. "OFFICE" MEANS THE OFFICE OF THE  EMPIRE BLUE CROSS AND BLUE SHIELD
INSPECTOR GENERAL CREATED BY THIS SECTION.
  2.  OFFICE  OF  EMPIRE  BLUE  CROSS AND BLUE SHIELD INSPECTOR GENERAL;
CREATION.  A. THERE IS HEREBY CREATED IN THE DEPARTMENT  OF  LAW  WITHIN
THE  OFFICE OF THE DEPUTY ATTORNEY GENERAL FOR MEDICAID FRAUD CONTROL AN
OFFICE OF THE EMPIRE BLUE CROSS AND BLUE SHIELD INSPECTOR  GENERAL.  THE
HEAD  OF  THE  OFFICE  SHALL  BE THE   EMPIRE BLUE CROSS AND BLUE SHIELD
INSPECTOR GENERAL, WHO SHALL BE APPOINTED BY THE GOVERNOR, BY  AND  WITH
THE ADVICE AND CONSENT OF THE SENATE.
  B.  THE  INSPECTOR SHALL SERVE FOR A TERM OF FIVE YEARS UNLESS REMOVED
BY THE GOVERNOR FOR NEGLECT OR MALFEASANCE IN OFFICE, AND  MAY  ALSO  BE
REMOVED  FOR  NEGLECT  OR  MALFEASANCE  BY  THE  SENATE  UPON  A VOTE OF
TWO-THIRDS OF ITS MEMBERS. AN INSPECTOR REMOVED FROM OFFICE MAY  NOT  BE
REAPPOINTED TO SUCH OFFICE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07245-01-1

S. 2609                             2
              

  C.  THE INSPECTOR MAY NOT BE EMPLOYED WITH THE DEPARTMENT OF INSURANCE
DURING HIS OR HER EMPLOYMENT WITH THE OFFICE OR WITHIN TWO  YEARS  AFTER
TERMINATING EMPLOYMENT WITH THE OFFICE.
  3.  FUNCTIONS,  DUTIES  AND RESPONSIBILITIES. THE INSPECTOR SHALL HAVE
THE FOLLOWING FUNCTIONS, DUTIES AND RESPONSIBILITIES:
  A. TO APPOINT SUCH DEPUTIES, DIRECTORS, ASSISTANTS AND OTHER  OFFICERS
AND  EMPLOYEES AS MAY BE NEEDED FOR THE PERFORMANCE OF HIS OR HER DUTIES
AND MAY PRESCRIBE THEIR POWERS AND FIX  THEIR  COMPENSATION  WITHIN  THE
AMOUNTS APPROPRIATED THEREFOR;
  B. TO CONDUCT AND SUPERVISE INVESTIGATIONS OF THE ACTIVITIES OF EMPIRE
BLUE  CROSS  AND  BLUE  SHIELD  AND, TO THE GREATEST EXTENT POSSIBLE, TO
COORDINATE  WITH THE SUPERINTENDENT OF INSURANCE;
  C.  TO KEEP THE GOVERNOR, ATTORNEY  GENERAL,  STATE  COMPTROLLER,  THE
TEMPORARY  PRESIDENT AND  MINORITY LEADER OF THE SENATE, THE SPEAKER AND
THE MINORITY AND MAJORITY LEADERS OF THE ASSEMBLY, APPRISED OF FRAUD AND
ABUSE;
  D. TO PROSECUTE FRAUD, ABUSE OR ILLEGAL ACTS PERPETRATED WITHIN EMPIRE
BLUE CROSS AND BLUE SHIELD;
  E. TO MAKE INFORMATION AND EVIDENCE RELATING TO CRIMINAL ACTS WHICH HE
OR SHE MAY OBTAIN IN CARRYING OUT HIS OR HER DUTIES AVAILABLE TO  APPRO-
PRIATE LAW ENFORCEMENT OFFICIALS AND LOCAL DISTRICT ATTORNEYS TO COORDI-
NATE INVESTIGATIONS AND CRIMINAL PROSECUTIONS;
  F.  TO  SUBPOENA  WITNESSES,  ADMINISTER  OATHS  OR AFFIRMATIONS, TAKE
TESTIMONY AND COMPEL THE PRODUCTION OF SUCH BOOKS, PAPERS,  RECORDS  AND
DOCUMENTS  AS  HE  OR  SHE  MAY  DEEM TO BE RELEVANT TO AN INVESTIGATION
UNDERTAKEN PURSUANT TO THIS SECTION;
  G. TO MONITOR THE IMPLEMENTATION BY THE RELEVANT OFFICE OF HIS OR  HER
RECOMMENDATIONS AND THOSE OF OTHER INVESTIGATIVE AGENCIES;
  H.  TO  RECOMMEND POLICIES RELATING TO THE PREVENTION AND DETECTION OF
FRAUD AND ABUSE OR THE IDENTIFICATION AND PROSECUTION OF PARTICIPANTS IN
SUCH FRAUD OR ABUSE; AND
  I. TO RECEIVE COMPLAINTS OF ALLEGED FAILURES OF STATE AND LOCAL  OFFI-
CIALS TO PREVENT, DETECT AND PROSECUTE FRAUD AND ABUSE.
  4.  COOPERATION  OF  AGENCY OFFICIALS AND EMPLOYEES. A. IN ADDITION TO
THE AUTHORITY OTHERWISE PROVIDED BY  THIS  SECTION,  THE  INSPECTOR,  IN
CARRYING OUT THE PROVISIONS OF THIS SECTION, IS AUTHORIZED:
  (I)  TO  HAVE  FULL  AND  UNRESTRICTED ACCESS TO ALL RECORDS, REPORTS,
AUDITS, REVIEWS, DOCUMENTS, PAPERS, RECOMMENDATIONS  OR  OTHER  MATERIAL
AVAILABLE  TO THE DEPARTMENT OF INSURANCE RELATING TO PROGRAMS AND OPER-
ATIONS WITH RESPECT TO WHICH THE INSPECTOR  HAS  RESPONSIBILITIES  UNDER
THIS SECTION;
  (II) TO MAKE SUCH INVESTIGATIONS RELATING TO THE ADMINISTRATION OF THE
PROGRAMS  AND  OPERATIONS  OF THE DEPARTMENT OF INSURANCE AS ARE, IN THE
JUDGMENT OF THE INSPECTOR, NECESSARY OR DESIRABLE; AND
  (III) TO REQUEST SUCH INFORMATION, ASSISTANCE AND COOPERATION FROM ANY
FEDERAL, STATE OR LOCAL GOVERNMENTAL DEPARTMENT, BOARD, BUREAU,  COMMIS-
SION,  OR  OTHER AGENCY OR UNIT THEREOF AS MAY BE NECESSARY FOR CARRYING
OUT THE DUTIES AND RESPONSIBILITIES ENJOINED UPON HIM  OR  HER  BY  THIS
SECTION. STATE AND LOCAL AGENCIES OR UNITS THEREOF ARE HEREBY AUTHORIZED
AND DIRECTED TO PROVIDE SUCH INFORMATION, ASSISTANCE AND COOPERATION.
  B.  NOTWITHSTANDING  ANY OTHER PROVISION OF LAW, RULE OR REGULATION TO
THE CONTRARY, NO PERSON SHALL PREVENT, SEEK TO PREVENT, INTERFERE  WITH,
OBSTRUCT  OR OTHERWISE HINDER ANY INVESTIGATION BEING CONDUCTED PURSUANT
TO THIS SECTION. ANY VIOLATION OF THIS PARAGRAPH SHALL CONSTITUTE  CAUSE
FOR SUSPENSION OR REMOVAL FROM OFFICE OR EMPLOYMENT.

S. 2609                             3

  5.  ESTABLISHMENT  PERIOD.  THE  GOVERNOR  SHALL  NOMINATE THE INITIAL
INSPECTOR AS SOON AS IS PRACTICABLE BUT IN NO  EVENT  LATER  THAN  SIXTY
DAYS AFTER THE EFFECTIVE DATE OF THIS SECTION.
  6.  REPORTS  REQUIRED  OF THE INSPECTOR. THE INSPECTOR SHALL, NO LATER
THAN FEBRUARY FIRST OF EACH YEAR, SUBMIT  TO  THE  GOVERNOR,  THE  STATE
COMPTROLLER, THE ATTORNEY GENERAL AND THE LEGISLATURE A REPORT SUMMARIZ-
ING THE ACTIVITIES OF THE OFFICE DURING THE PRECEDING CALENDAR YEAR.
  7.  DISCLOSURE  OF  INFORMATION.  A.  THE INSPECTOR SHALL NOT PUBLICLY
DISCLOSE INFORMATION WHICH IS:
  (I) A PART OF ANY ONGOING INVESTIGATION; OR
  (II) SPECIFICALLY PROHIBITED FROM DISCLOSURE BY ANY OTHER PROVISION OF
LAW.
  B. NOTWITHSTANDING PARAGRAPH A OF THIS SUBDIVISION, ANY  REPORT  UNDER
THIS  SECTION  MAY  BE  DISCLOSED TO THE PUBLIC IN A FORM WHICH INCLUDES
INFORMATION WITH RESPECT TO A PART OF AN ONGOING CRIMINAL  INVESTIGATION
IF SUCH INFORMATION HAS BEEN INCLUDED IN A PUBLIC RECORD.
  S 2. This act shall take effect immediately.