Source: http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=SB532%20SUB1.htm&yr=2011&sesstype=RS&i=532
Timestamp: 2018-02-20 06:27:22
Document Index: 143816161

Matched Legal Cases: ['§9', '§9', '§9', '§9', '§9', '§9', '§9', '§9', '§9', '§9', '§9', '§9', '§9']

SB532 SUB1 Senate Bill 532 History
(By Senators Palumbo, Foster and Minard)
A BILL to amend and reenact §9-7-1, §9-7-2, §9-7-3, §9-7-4, §9-7-5, §9-7-6 and §9-7-8 of the Code of West Virginia, 1931, as amended; and to amend said code by adding thereto three new sections, designated §9-7-3a, §9-7-5a and §9-7-6a, all relating to the Department of Health and Human Resources; fraud and abuse in the Medicaid program; powers and duties of the Medicaid Fraud Control Unit; definitions under said article; investigation procedures for the Medicaid Fraud Control Unit; Medicaid Fraud Unit lawyers assisting prosecutors in Medicaid crimes; Medicaid crimes and criminal penalties; venue for crimes committed against Medicaid; limiting the liability of employees of the Department of Health and Human Resources; and other remedies and criminal penalties.
(a) It is the purpose of the Legislature to continue the Medicaid Fraud Control Unit previously established within the West Virginia Department of Welfare Health and Human Resources and to provide it with the responsibility and authority for investigating and controlling fraud and abuse of the medical programs of the state Department of welfare Health and Human Resources which have been established pursuant to section two, article four of this chapter. It is the finding of the Legislature that substantial sums of money have been lost to the state and federal government in the operation of the medical programs of the state due to the overpayment of moneys to medical providers. Such overpayments have been the result of both the abuse of and fraud in the reimbursement process.
(b) The Medicaid fraud control unit of the state Department of welfare Health and Human Resources shall be continued and shall have the following powers and duties:
(1) The investigation and referral for prosecution of all violations of applicable state and federal laws pertaining to the provision of goods or services under the medical programs of the state including the Medicaid program and the program known as handicapped children's services.
(2) The investigation of complaints alleging abuse, or neglect or financial exploitation of patients in health care facilities which receive payments under the medical programs of the state.
(3) "Claim" means an application for payment for goods or services provided under the medical programs of the Department of welfare Health and Human Resources.
(4) “Entity” means any corporation, association or partnership.
(5) “Financial Exploitation” means the intentional misappropriation or misuse of funds or assets of another.
(4) (6) "Medicaid" means that assistance provided under a state plan implemented pursuant to the provisions of subchapter nineteen, chapter seven, Title 42, United States Code, as that chapter has been and may hereafter be amended.
(7) “Person” means any individual, corporation, association, partnership, proprietor, agent, assignee or entity.
(5) (8) "Provider" means any individual or entity furnishing goods or services under the medical programs of the Department of welfare Health and Human Resources.
(6) (9) "Unit" means the Medicaid Fraud Control Unit established under section one of this article.
(a) When the unit has probable cause to believe that information that indicates a person has engaged in an act or activity which is subject to prosecution under this article, the unit shall make an investigation to determine if the act has been committed and, to the extent necessary for such purpose, the commissioner Secretary, or an employee of the unit designated by the commissioner Secretary, shall have the power to may administer oaths or affirmations, present and swear or affirm criminal complaints, request search warrants and issue subpoenas for witnesses and documents relevant to the investigation, including information concerning the existence, description, nature, custody, condition and location of any book, record, documents or other tangible thing and the identity and location of persons having knowledge of relevant facts or any matter reasonably calculated to lead to the discovery of admissible evidence.
(a) A person shall not knowingly make or cause to be made a false statement or false representation of any material fact in an application for medical assistance under the medical programs of the Department of welfare Health and Human Resources.
(b) A person shall not knowingly make or cause to be made a false statement or false representation of any material fact necessary to determine the rights of any other person to medical assistance under the medical programs of the Department of welfare Health and Human Resources.
(c) A person shall not knowingly and intentionally conceal or fail to disclose any fact with the intent to obtain medical assistance under the medical programs of the Department of welfare Health and Human Resources to which the person or any other person is not entitled.
(d) Any person found to be in violation of subsection (a), (b) or (c) of this section shall be is guilty of a felony and, upon conviction, shall be confined in the penitentiary imprisoned in a state correctional facility not less than one nor more than ten years, or shall be fined not to exceed ten thousand dollars or both fined and imprisoned. as provided.
(a) A person shall not knowingly and willfully solicit, offer, pay or receive any remuneration to induce referrals of items or services covered by the medical services fund established pursuant to section two, article four of this chapter, which is not otherwise authorized by applicable laws or rules and regulations. governing said medical services fund.
(b) A person shall not make or present or cause to be made or presented to the Department of welfare Health and Human Resources a claim under the medical programs of the Department of welfare Health and Human Resources knowing the claim to be false, fraudulent or fictitious.
(c) A person shall not enter into an agreement, combination or conspiracy to obtain or aid another to obtain the payment or allowance of a false, fraudulent or fictitious claim under the medical programs of the Department of welfare Health and Human Resources.
(d) Any person found to be in violation of subsection (a), (b) or (c) of this section shall be guilty of a felony and, upon conviction, shall be confined in the penitentiary imprisoned in a state correctional facility not less than one nor more than ten years or shall be fined not to exceed ten thousand dollars, or both fined and imprisoned. as provided.
A criminal prosecution under this article may be commenced in the circuit court of any county in which:
(b) Any of the conduct constituting a violation of any provision of this article shall have occurred.
(a) Any person, firm, corporation or other entity which willfully, by means of a false statement or representation, or by concealment of any material fact, or by other fraudulent scheme, devise or artifice on behalf of himself, herself, itself, or others, obtains or attempts to obtain benefits or payments or allowances under the medical programs of the Department of welfare Health and Human Resources to which he or she or it is not entitled, or, in a greater amount than that to which he or she or it is entitled, shall be liable to the Department of welfare Health and Human Resources in an amount equal to three times the amount of such benefits, payments or allowances to which he or she or it is not entitled, and shall be liable for the payment of reasonable attorney fees and all other fees and costs of litigation.
(c) A civil action under this section may be prosecuted and maintained on behalf of the Department of welfare Health and Human Resources by the Attorney General and his the Attorney General’s assistants or a prosecuting attorney and his the prosecuting attorney’s assistants or by any attorney in contract with or employed by the Department of welfare Health and Human Resources to provide such representation.
There shall be no civil liability on the part of, and no cause of action shall arise against the Secretary or the Department of Health and Human Resources or its employees or agents for any action taken by them in the lawful performance of their powers and duties under this article.
The remedies and penalties provided in this article governing the operation of the medical programs of the Department of welfare Health and Human Resources.
§9-7-3a, §9-7-5a and §9-7-6a are new; therefore, strike-throughs and underscoring have been omitted.