BILL NUMBER: S5449

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:

Section 1. requires the State to reimburse counties 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.

Section 2. states the effective date.

 
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 soft-
ware 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 therefore 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 prosecute 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:
2012: S4614

2014: S3284

2016: 51444

2018: S2821

2020: S949

 
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.