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Medicaid Fraud bill needs compromise to pass

May 10, 2006
By: John Amick
State Capital Bureau
Links: SB 1210

JEFFERSON CITY - A compromise within the Missouri Legislature will be needed to rescue a Medicaid fraud bill that has become a highly contentious topic amongst the two houses in the final weeks of the 2006 legislative session.

Rep. Sam Page, D-Creve Coeur, said the Missouri House will add amendments to the bill to make clear the legislation is not after small providers or small billing errors, but those providers who intentionally try to scam the system.

"We're hopeful to send it to the Senate on Friday," said Page, member of the Special Committee on Healthcare Facilities and the committee on Healthcare Policy and a physician certified in anesthesiology and pain management.

The Medicaid provider fraud bill, sponsored by Sen. Chris Koster, R-Harrisonville, passed through the Missouri Senate with relative ease last month.

But the bill stalled in the House -- prompting calls by Gov. Matt Blunt for the House to take up the bill.

The proposal ran into resistance in the House Healthcare Facilities Committee -- particularly provisions that would allow lawsuits against doctors and hospitals by private persons for suspected Medicaid fraud.

The committee took out the penalizing language of the bill they deemed harsh and then offered the bill to the House floor. The penalizing language they removed included an 85 percent provision where fraudulent providers, guilty of illegally taking in excess of $50,000 from Medicaid recipients, would have to serve 85 percent of their acquired prison sentence.

A lifetime ban from the Medicaid system for providers found guilty of fraud and the ability of whistleblowers to file Medicaid fraud suits with a private attorney and not the Attorney General were other provisions removed by the committee.

Regarding the whistleblower provision that would require a fraud suit to be taken up by the state's Attorney General, chairman of the committee, Rep. Robert Schaaf, R-St. Joseph, wanted to avoid frivolous lawsuits that could be thrust upon health care providers by private attorneys.

"We don't want private cause of action to be at play here," Schaaf said. "If there's fraud to be investigated let's have the legal representative of the law (the Attorney General) call out fraudulent providers, not private attorneys."

The whistleblower provision in the Senate's version of the bill allowed for the whistleblower to receive up to 20 to 35 percent of the proceeds won in a fraud lawsuit. The House version lowered that number, allowing compensation of up to 10 percent of money recovered.

"(Giving) whistleblowers the tools to point out fraud is key here," Schaaf said.

Page agreed.

"Its important for us to see that whistleblowers are protected and receive compensation for their efforts," he said.

The bill, SB 1210, has limited time to pass with the legislative session ending this Friday at 6:00 p.m.