Bill Text: HI HB985 | 2013 | Regular Session | Introduced
Bill Title: Medicaid; Fraudulent Claims
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2013-02-14 - The committee(s) on HUS recommend(s) that the measure be deferred. [HB985 Detail]
Download: Hawaii-2013-HB985-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
985 |
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TWENTY-SEVENTH LEGISLATURE, 2013 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that across the United States, state medicaid programs pay approximately $18,000,000,000 each year that is attributable to fraud, waste, and abuse. The legislature further finds that, in order to reduce the amount of money lost in Hawaii to fraud, waste, and abuse, the agency that administers Hawaii's medicaid adult and children's health insurance programs should implement modern pre-payment and recovery technologies. The legislature believes that the savings achieved by effective claims management will cover the cost of implementing and administering these new technologies.
The purpose of this Act is to require the department of human services to adopt technologies that reduce amounts lost to fraudulent, wasteful, and abusive reimbursement claims.
SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- Fraudulent claims; prevention. (a) The department shall implement a provider data verification and provider screening technology to automate reviews of claims for reimbursement and to identify and prevent overpayment or inappropriate payment to deceased providers, sanctioned providers, providers with expired licenses or credentials, retired providers, and confirmed wrong addresses.
(b) The department shall adopt and implement predictive modeling and analytics technologies into existing medicaid adult and children's health insurance program claim processing procedures that:
(1) Identify and analyze billing or utilization patterns that present a high risk of fraudulent activity;
(2) Analyze necessary information before claims are paid, minimize disruptions to the claims processing procedures, and speed claims resolution;
(3) Prioritize identified transactions for additional review before claims payments are made based upon likelihood of potential waste, fraud, or abuse;
(4) Capture outcome information from adjudicated claims to allow for refinement and enhancement of the predictive analytics technologies based upon historical data and algorithms within the system; and
(5) Prevent the payment of claims for reimbursement that are identified as potentially wasteful, fraudulent, or abusive until those claims have been automatically verified as valid."
SECTION 3. New statutory material is underscored.
SECTION 4. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Medicaid; Fraudulent Claims
Description:
Directs DHS to implement automated systems to detect and prevent fraudulent, wasteful, and abusive medicaid claims.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
