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Bi-partisan support for health care initiatives

March 28, 2006
By: John Amick
State Capital Bureau
Links: SB 1091 & SB 1210

JEFFERSON CITY - Cracking down on Medicaid fraud became the subject of rare partisan agreement in the year-long debate on restructuring the state's program providing health care coverge for the lower income.

The Senate's General Laws Committee approved a bi-partisan bill to toughen penalties against health care providers that cheat the state in submitting Medicaid bills.

"People who have stolen Medicaid money from those who need it are creating victims in Missouri," said Sen. Chuck Graham, D-Columbia.

Bills sponsored by Sen. Graham, Sen. Chris Koster, R-Harrisonville, and Sen. John Loudon, R-Ballwin, will be fused together in an attempt to root out waste, fraud, and abuse within Missouri's Medicaid system.

Compensating whistleblowers of Medicaid fraud is a major point of contention amongst the bills. There are currently no financial incentives promised to whistleblowers of fraud in Missouri.

Koster's bill would require a person convicted of Medicaid fraud serve 85 percent of the sentence being eligible for parole. Koster said the "85 Percent Rule" usually is reserved for violent crimes, such as murder, sexual assault, and kidnapping.

"This is a statement of how seriously the government and legislature of Missouri takes this offense," said Sen. Koster, a former prosecutor.

If the 85 Percent Rule is attached to Medicaid fraud, it would be the first time it would be applied to white collar crime in Missouri, Koster said.

Senate President Pro Tem Mike Gibbons, R-Kirkwood, voiced apprehension to applying the harsh rule to this one particular white collar crime and not others.

"I'm not sure I'm ready to apply a violent crime standard to this crime (Medicaid fraud)," he said.

Sen. Graham pointed out that a proper penalty is needed, as many white collar criminals are increasingly repeat offenders and must be significantly punished.

"I know people are going from company to company, re-offending over and over. Something must be done."

The combined legislation would allow individuals to sue providers for Medicaid fraud. It would also include numerous revisions to current law relating to the reporting and investigating of system fraud.

One major addition to current law would be a lifetime ban for any supplier convicted of Medicaid fraud beyond a reasonable doubt.

"This legislation would dramatically change policy of the state," said Sen. Jason Crowell of Cape Giradeau, the committee's chairman.

Anywhere from $200-$500 million is lost every year to Medicaid fraud in Missouri, Koster said.

The committee also decided to roll together bills that would create a "Missouri Prescription Drug Website." The bills, SB 1091 and 1239, would establish a Website that provided "pricing information on the fifty most commonly used prescription drugs in Missouri."

The Website, in conjunction with the Social Services Department would provide retail prices for brand name and generic prescription drugs from each pharmacy for a standard thirty-day supply.

"Passing this legislation would be true cost saving for consumers," said a representative of the AARP.

The legislation of Medicaid fraud and the Missouri Prescription Drug Website, respectively, will now be sent to the Senate floor for full chamber debate.