Bill Text: IN SB0559 | 2013 | Regular Session | Amended
Bill Title: Fraud.
Spectrum: Partisan Bill (Republican 5-0)
Status: (Passed) 2013-05-13 - Public Law 197 [SB0559 Detail]
Download: Indiana-2013-SB0559-Amended.html
Citations Affected: IC 7.1-2; IC 12-7; IC 12-13; IC 12-15; IC 20-26.
Synopsis: Fraud. Requires the state excise police to investigate
allegations of electronic benefit transfer (EBT) fraud. Requires the
division of family resources to establish a process for certain recipients
to follow in order to receive a replacement EBT card. Sets forth the
Medicaid ineligibility time frame for a person who is convicted of
forgery, fraud, legend drug deception, and other deceptions related to
the application for or receipt of Medicaid assistance. Requires a
transportation provider that applies to enroll in the Medicaid program
to file with the office of Medicaid policy and planning a surety bond to
be used for specified purposes. Requires the office of Medicaid policy
and planning to visit certain Medicaid providers and provider
applicants if certain conditions are met. Requires a national criminal
history background check on certain Medicaid provider applicants at
the cost of the applicant. Allows an audit and inspection of completed
lunch school program applications to ensure that applicants meet the
requirements to participate in the program.
Effective: July 1, 2013.
January 14, 2013, read first time and referred to Committee on Health and Provider
Services.
January 31, 2013, amended; reassigned to Committee on Tax and Fiscal Policy.
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or
A BILL FOR AN ACT to amend the Indiana Code concerning
fraud.
(b) "Person", for purposes of IC 12-13-14, has the meaning set forth in IC 12-13-14-1.
(c) "Person", for purposes of IC 12-17.2, means an individual who is at least twenty-one (21) years of age, a corporation, a partnership, a voluntary association, or other entity.
(d) "Person", for purposes of IC 12-15-2-20, means an
individual who is:
(1) at least twenty-one (21) years of age; and
(2) applying for or receiving Medicaid assistance.
(1) Applicants.
(2) Recipients.
(3) Retailers that participate in the EBT program.
(4) Individuals who sell or purchase access to cash assistance benefits in violation of any federal or state law or regulation.
(b) The division may deny replacement of an EBT card if the recipient seeking replacement of the EBT card does not follow the procedure established by the division under subsection (a).
(b) The office shall adopt rules under IC 4-22-2 or issue a Medicaid provider bulletin setting forth procedures and standards for the visit required under this section.
(1) IC 35-43-5; or
(2) IC 35-43-10;
related to the application for or receipt of Medicaid assistance is ineligible to receive Medicaid assistance under this article for the following time:
(1) One (1) year if the conviction is for the person's first offense.
(2) Two (2) years if the conviction is for the person's second offense.
(3) Ten (10) years
(b) A person's ineligibility period for Medicaid assistance described in subsection (a) begins either:
(1) on the date the person is sentenced, if the person's sentence does not include incarceration; or
(2) on the date the individual is released from incarceration.
(c) Upon receipt of substantiated evidence that a person has committed fraud concerning the application for or receipt of Medicaid assistance, the office may remove the person from receiving Medicaid assistance for one (1) year. If the office determines that a person receiving Medicaid assistance is to be removed from receiving Medicaid assistance under this subsection, the person may appeal the determination. An appeal under this subsection is subject to IC 4-21.5.
(d) The office may adopt rules under IC 4-22-2 to implement this section.
(1) that is a common carrier, including a person that provides transportation by a taxi;
(2) that:
(A) is enrolled; or
(B) applies for enrollment;
in the Medicaid program as a Medicaid provider to render transportation services to Medicaid recipients; and
(3) that is not a nonprofit organization exempt from taxation under Section 501(c)(3) of the Internal Revenue Code.
(b) A transportation provider that applies for enrollment as a Medicaid provider:
(1) as a new applicant;
(2) due to a change in ownership of a transportation provider currently enrolled; or
(3) due to a purchase or transfer of the assets of a transportation provider currently enrolled;
shall, at the time the transportation provider files a provider
agreement with the office, submit to the office a surety bond that
meets the requirements of subsection (d) and is issued by a surety
that is authorized by the office of the secretary.
(c) The secretary may waive the surety bond requirement of
subsection (b) for a transportation provider if, in the secretary's
sole discretion, the secretary determines that the transportation
provider renders or will render transportation services in an
underserved area, as classified by applicable federal or state
designations.
(d) The following apply to a surety bond filed with the office
under this section:
(1) The surety bond must be continuously in effect for at least
three (3) years after the application is made as described in
subsection (b).
(2) The surety bond must provide coverage for liability of at
least fifty thousand dollars ($50,000).
(3) The surety bond must name the:
(A) transportation provider as the principal;
(B) office as the obligee; and
(C) person that issues the surety bond, including the
person's heirs, executors, administrators, successors, and
assignees, jointly and severally, as surety.
(4) The surety bond must provide the surety's name, street
address or post office box number, city, state, and ZIP code.
(5) The surety bond must provide that the surety is liable
under the surety bond for a duplicate, erroneous, or false
Medicaid claim paid by the office or its fiscal agent to the
transportation provider during the term of the surety bond.
(6) The surety bond must guarantee that the surety will, not
later than thirty (30) days after the surety receives written
notice from the office containing sufficient evidence to
establish the surety's liability under the surety bond as
described in subdivision (5), pay to the office the following
amounts, not to exceed the full amount of the surety bond:
(A) The amount of the duplicate, erroneous, or false claim
that was previously paid by the office or its fiscal agent to
the transportation provider, plus accrued interest.
(B) An assessment imposed under IC 12-15-22 by the office
on the transportation provider.
(7) The surety bond must provide that if the transportation
provider's provider agreement is not renewed or is
terminated, the surety bond submitted by the transportation
provider remains in effect until the last day of the surety bond
coverage period and the surety remains liable for a duplicate,
erroneous, or false claim paid by the office or its fiscal agent
to the transportation provider during the term of the surety
bond.
(8) The surety bond must provide that actions under the
surety bond may be brought by the office or the attorney
general.
(e) The office may revoke or deny a provider agreement for a
transportation provider's failure to comply with this section.
(f) The office may revoke a provider agreement if a
transportation provider cancels a surety bond required by this
section.
(g) The office or its designee may, at any time, require a
transportation provider to demonstrate compliance with this
section.
(h) If:
(1) a surety has paid the office for a liability incurred under
a surety bond under this section; and
(2) the transportation provider is subsequently successful in
appealing the determination of liability;
the office shall, upon completion of the appellate process, refund
the surety or the transportation provider the full amount paid for
the liability.
(1) Include information that the office determines necessary to facilitate carrying out of IC 12-15.
(2) Prohibit the provider from requiring payment from a recipient of Medicaid, except where a copayment is required by law.
(3) Require the submission of necessary information, forms, or consents for the office to obtain a national criminal history background check through the state police department under IC 10-13-3-39 of any person who holds at least a five percent (5%) ownership interest in a facility or entity in which the provider applicant plans to provide Medicaid services under the provider agreement. The provider applicant is responsible for the cost of the national criminal history background check.
desiring to participate in the Medicaid program by providing physician
services as a managed care provider must enter into a provider
agreement with the office or the contractor under IC 12-15-30 to
provide Medicaid services.
(b) Before the office may approve a provider agreement, the
office shall visit the facility or entity in which the provider
applicant plans to provide Medicaid services under a provider
agreement. The office shall adopt rules under IC 4-22-2 or issue a
Medicaid provider bulletin setting forth procedures and standards
for the visit required under this subsection.
(b) The accounts and records shall:
(1) be available for inspection and audit at all times by authorized officials; and
(2) be preserved for at least five (5) years, as the state superintendent may prescribe.
(c) The state superintendent shall conduct or cause to be conducted any audits, inspections, and administrative reviews of completed applications, acts, records, and operations of a school lunch program necessary to do the following:
(1) Determine whether agreements with the governing body and rules under this chapter are being complied with.
(2) Ensure that a school lunch program is effectively administered.
(3) Ensure that participants meet all requirements to participate in the school lunch program.
