NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5083
SPONSOR: Palmesano (MS) TITLE OF BILL:
An act to amend the social services law, in relation to the state
reimbursement of county payments for medical assistance fraud, waste and
abuse detection software
PURPOSE OR GENERAL IDEA OF BILL:
To provide fiscal relief to counties in combating Medical fraud, waste
and abuse through the use of data mining software.
SUMMARY OF PROVISIONS:
Amends the social services law by adding a new paragraph (aa) to section
368-a of the social services law to require the State to reimburse coun-
ties if such county has previously purchased or intends to purchase data
mining software that detects inaccuracies in the Medicaid system.
Further defines "data mining software" as a database application that
utilizes advanced data searching capabilities and statistical analyses
to discover patterns and correlations in the use and abuse of medical
assistance practices.
JUSTIFICATION:
New York State's Medicaid program is the largest and most costly in the
nation. Although New York has seven percent of the U.S. population,
Medicaid cost the State approximately $16.5 billion in 2007 - 33 percent
more than California, which maintains the nation's second largest Medi-
caid system. Between DOH and the State's Medicaid Fraud Control Unit
(MFCU), New York spends more than $130 million to combat fraud. Further,
statistics indicate that fraud equals about ten percent of total Medi-
caid dollars spent each year in New York State.
Medicaid costs are the largest part of county budgets and fraud, waste
and abuse (FWA) consume a good portion of these budgets. Providing fund-
ing to counties to do their own FWA investigations would free up
resources at the State level for more complicated cases. Counties can
immediately determine where there may be a problem by drilling through
reimbursement data, thus giving them better control of their Medicaid
dollars and become more accountable to the taxpayer.
Additionally, smaller counties have cited numerous concerns over paying
for this software themselves, although many of them are supportive of
the concept. Counties such as Franklin, Clinton and Essex already do not
have enough staff assigned, to the task of investigating FWA, and there-
fore cannot pay for software and hire additional staff to utilize this
software for these investigations. Furthermore, they have indicated
that if the State is dedicated to having the counties investigate and
prosecute FWA then they should also dedicate: the funds to do so.
Combating fraud, waste and abuse is the first step in fixing a broken
system. The Medicaid program itself was established with honest
intentions and it is our duty to preserve it so that those individuals
who need Medicaid services the most receive them, and those who are
utilizing Medicaid fraudulently are prosecuted accordingly.
PRIOR LEGISLATIVE HISTORY:
2021-2022, A.4876: referred to Social Services
2019-2020, A.3540: held for consideration in Social Services
2017-2018, A.4744: referred to Social Services
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Undetermined at this time. However, any cost would conceivably be accom-
plished through FWA investigation, prosecution and deterrence.
EFFECTIVE DATE:
This bill shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
5083
2023-2024 Regular Sessions
IN ASSEMBLY
March 2, 2023
___________
Introduced by M. of A. PALMESANO, BRABENEC, DeSTEFANO, DiPIETRO,
J. M. GIGLIO, LEMONDES, MANKTELOW, McDONOUGH, MORINELLO, NORRIS,
TAGUE, WALSH -- Multi-Sponsored by -- M. of A. BARCLAY, BLANKENBUSH --
read once and referred to the Committee on Social Services
AN ACT to amend the social services law, in relation to the state
reimbursement of county payments for medical assistance fraud, waste
and abuse detection software
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 1 of section 368-a of the social services law
2 is amended by adding a new paragraph (aa) to read as follows:
3 (aa) (i) Notwithstanding any other provision of law, the full amount
4 expended by the local social services district for medical assistance
5 fraud, waste and abuse investigations via the use of data mining soft-
6 ware shall be reimbursed by the state if the county has previously
7 purchased or intends to purchase such software. For the purposes of this
8 paragraph, "data mining software" shall mean a database application that
9 utilizes advanced data searching capabilities and statistical analyses
10 to discover patterns and correlations in the use and abuse of medical
11 assistance practices. Any county that has previously purchased such
12 software must supply adequate documentation, including any receipts,
13 that details such purchase. The state shall disburse grants, when appli-
14 cable, from the general fund for this purpose.
15 (ii) The commissioner of health may develop rules and regulations as
16 necessary to carry out the provisions of this paragraph.
17 § 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05360-01-3
