Bill Text: PA HB1669 | 2011-2012 | Regular Session | Introduced

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Bill Title: Providing for oversight of the integrity of health care programs; and imposing penalties.

Spectrum: Strong Partisan Bill (Democrat 12-1)

Status: (Introduced - Dead) 2011-06-15 - Referred to INSURANCE [HB1669 Detail]

Download: Pennsylvania-2011-HB1669-Introduced.html

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PRINTER'S NO. 2111
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1669 Session of2011
INTRODUCED BY DeLUCA, CALTAGIRONE, D. COSTA, M. O'BRIEN, JOSEPHS, THOMAS, DALEY, FABRIZIO, MATZIE, K. BOYLE, MOUL, W. KELLER AND GERBER, JUNE 15, 2011
REFERRED TO COMMITTEE ON INSURANCE, JUNE 15, 2011
AN ACT
Amending Title 35 (Health and Safety) of the Pennsylvania
Consolidated Statutes, providing for oversight of the
integrity of health care programs; and imposing penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 35 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
Chapter
CHAPTER 63
OVERSIGHT OF THE INTEGRITY OF HEALTH CARE PROGRAMS
Sec.
6301. Scope of chapter.
6302. Definitions.
6303. Medicaid fraud, disqualification for license, certificate
or registration.
6304. Executive agencies regulation of health care providers
activities.
6305. Temporary suspension.
§ 6301. Scope of chapter.
This chapter relates to oversight of the integrity of health
care programs.
§ 6302. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Children's Health Insurance Program." The Children's Health
Care Program established under Article XXIII of the act of May
17, 1921 (P.L.682, No.284), known as The Insurance Company Law
of 1921.
"Fraud." An intentional deception or misrepresentation made
by a person with the knowledge that the deception results in
unauthorized benefit to the person or another person. The term
includes any act that constitutes fraud under applicable Federal
or State law.
"Health care program." A health care program administered,
managed or financed through an executive agency of the
Commonwealth, such as the Children's Health Insurance Program or
the Medicaid program.
"Health care provider" or "provider." All of the following:
(1) A primary health care center or a person, including
a corporation, university or other educational institution,
licensed or approved by the Commonwealth to provide health
care or professional medical services as a physician, a
certified nurse midwife, a dentist, a pharmacist, a
podiatrist, hospital, nursing home or birth center.
(2) A person receiving compensation or reimbursements
from a health care program.
"Medical assistance" or "Medicaid." The State program of
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medical assistance established under the act of June 13, 1967
(P.L.31, No.21), known as the Public Welfare Code.
§ 6303. Medicaid fraud, disqualification for license,
certificate or registration.
(a) General rule.--Fraud against Medicaid or a health care
program in the practice of a health care profession is
prohibited.
(b) Disqualification.--In addition to the grounds provided
under other statutes or regulations, each licensing authority
shall refuse to admit a candidate to any examination and refuse
to issue or renew a license, certificate or registration to any
applicant if the candidate or applicant or any principal,
officer, agent, managing employee or affiliated person of the
applicant has been:
(1) Convicted of, or entered a plea of guilty or nolo
contendere to, regardless of adjudication, a felony under 18
Pa.C.S. (relating to crimes and offenses) or 21 U.S.C. §§
801-970, unless the sentence and any subsequent period of
probation for the conviction or pleas ended more than 15
years prior to the date of the application.
(2) Terminated for cause from a health care program
unless the applicant has been in good standing with the
Medicaid or health care program for the most recent five
years.
(3) Terminated for cause, pursuant to the appeals
procedures established by the Federal Government or the
Commonwealth, from any state Medicaid program, a health care
program or the Federal Medicare program, unless the applicant
has been in good standing with a state Medicaid program or
the Federal Medicare program for the most recent five years
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and the termination occurred at least 20 years prior to the
date of the application.
§ 6304. Executive agencies regulation of health care providers
activities.
(a) Grounds for denial and revocation.--In addition to the
grounds provided under other statutes or regulations, grounds
that may be used by the licensing agency for denying and
revoking a license or change of ownership application include
false representation of a material fact in the license
application or omission of any material fact from the
application by a controlling interest.
(b) Duty of licensing authority.--In addition to the grounds
provided under other statutes or regulations, each licensing
authority shall suspend or revoke a license, certificate or
registration of a principal, officer, agent, managing employee
or affiliated person that has been:
(1) Convicted of, or entered a plea of guilty or nolo
contendere to, regardless of adjudication, a felony under 18
Pa.C.S. (relating to crimes and offenses) or 21 U.S.C. §§
801-970, unless the sentence and any subsequent period of
probation for the conviction or pleas ended more than 15
years prior to the date of the application.
(2) Terminated for cause from a health care program,
unless the applicant has been in good standing with the
Medicaid or health care program for the most recent five
years.
(3) Terminated for cause, pursuant to the appeals
procedures established by the Federal Government or the
Commonwealth, from any state Medicaid program, a health care
program or the Federal Medicare program, unless the applicant
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has been in good standing with a state Medicaid program or
the Federal Medicare program for the most recent five years
and the termination occurred at least 20 years prior to the
date of the application.
§ 6305. Temporary suspension.
A license or certificate issued under any act may be
temporarily suspended for a violation of this chapter as the
General Assembly declares a violation of this chapter to be an
immediate and clear danger to the public health and safety. The
licensing agency shall issue an order to that effect without a
hearing, but upon due notice, to the licensee or certificate
holder concerned at his last known address, which shall include
a written statement of all allegations against the licensee or
certificate holder. The provisions of section 9 of the act of
December 20, 1985 (P.L.457, No.112), known as the Medical
Practice Act of 1985, or similar legislation shall not apply to
a temporary suspension. The licensing agency shall commence
formal action to suspend, revoke or restrict the license or
certificate of the person concerned as otherwise provided for
under this chapter. All actions shall be taken promptly and
without delay. Within 30 days following the issuance of an order
temporarily suspending a license, the licensing agency shall
conduct or cause to be conducted a preliminary hearing to
determine that there is a prima facie case supporting the
suspension. The licensee or certificate holder whose license or
certificate has been temporarily suspended may be present at the
preliminary hearing and may be represented by counsel, cross-
examine witnesses, inspect physical evidence, call witnesses,
offer evidence and testimony and make a record of the
proceedings. If it is determined that there is not a prima facie
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case, the suspended license shall be immediately restored. The
temporary suspension shall remain in effect until vacated by the
licensing agency, but in no event longer than 180 days, unless
agreed to by the licensee or certificate holder.
Section 2. Agencies and departments charged with duties and
responsibilities under 35 Pa.C.S. Ch. 63 may promulgate all
rules and regulations necessary to implement 35 Pa.C.S. Ch. 63.
Section 3. This act shall take effect in 60 days.
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