BILL NUMBER: S949

SPONSOR: O'MARA
 
TITLE OF BILL:

An act to amend the social services law, in relation to the state
reimbursement of county payments for medical assistance fraud, waste and
abuse detection software

 
PURPOSE:

To provide fiscal relief to counties in combating Medical fraud, waste
and abuse through the use of data mining software.

 
SUMMARY OF PROVISIONS:

Amends the social services law by adding a new paragraph (aa) to section
368-a of the social services law to require the State to reimburse coun-
ties if such county has previously purchased or intends to purchase data
mining software that detects inaccuracies in the Medicaid system.
Further defines "data mining software" as a database application that
              

utilizes advanced data searching capabilities and statistical analyses
to discover patterns and correlations in the use and abuse of medical
assistance practices.

 
JUSTIFICATION:

New York State's Medicaid program is the largest and most costly in the
nation. Although New York has seven percent of the U.S.  population,
Medicaid cost the State approximately $46.5 billion in 2007 - 33 percent
more than California, which maintains the nation's second largest Medi-
caid system. Between DOH and the State's Medicaid Fraud Control Unit
(MFCU), New York spends more than $130 million to combat fraud. Further,
statistics indicate that fraud equals about ten percent of total Medi-
caid dollars spent each year in New York State.

Medicaid costs are the largest part of county budgets and fraud, waste
and abuse (FWA) consume a good portion of these budgets. Providing fund-
ing to counties to do their own FWA investigations would free up
resources at the State level for more complicated cases. Counties can
immediately determine where there may be a problem by drilling through
reimbursement data, thus giving them better control of their Medicaid
dollars and become more accountable to the taxpayer.

Additionally, smaller counties have cited numerous concerns over paying
for this software themselves, although many of them are supportive of
the concept. Counties such as Franklin, Clinton and Essex already do not
have enough staff assigned to the task of investigating FWA, and there-
fore cannot pay for software and hire additional staff to utilize this
software for these investigations. Furthermore, they have indicated that
if the State is dedicated to having the counties investigate and prose-
cute FWA then they should also dedicate the funds to do so.

Combating fraud, waste and abuse is the first step in fixing a broken
system. The Medicaid program itself was established with honest
intentions and it is our duty to preserve it so that those individuals
who need Medicaid services the most receive them, and those who are
utilizing Medicaid fraudulently are prosecuted accordingly.

 
LEGISLATIVE HISTORY:

2018-S.2821
2016-S.1444 2014-S.3284

 
FISCAL IMPLICATIONS:

Undetermined at this time. However, any cost would conceivably be accom-
plished through FWA investigation, prosecution and deterrence.

 
EFFECTIVE DATE:
This bill shall take effect immediately.