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S.F. No. 0083 |
Medicaid fraud recovery. |
Sponsored By: Senator(s) Peterson and Representative(s) Harvey
AN ACT relating to Medicaid; creating the Wyoming Medicaid False Claims Act; authorizing civil recoveries for the state as specified; providing duties of the attorney general and district attorneys; providing procedures; providing for a limitations period and applicability of the act; providing for admissibility of verdicts as specified; providing definitions; prescribing criminal penalties as specified for failure to maintain required records; creating a cause of action for retaliatory employment actions; and providing for an effective date.
1/7/2013 Bill Number Assigned
1/8/2013 S Received for Introduction
1/9/2013 S Introduced and Referred to S10
1/16/2013 S10 Recommended Amend and Do Pass
ROLL CALL
Ayes: Senator(s) Anderson, JL S28, Craft, Nutting, Peterson and Scott
Ayes 5 Nays 0 Excused 0 Absent 0 Conflicts 0
1/16/2013 S Placed on General File
SF0083SS001.01/ADOPTED (CORRECTED COPY)
[DIVIDED AMENDMENT]
Page 5-line 9 Delete "fifteen (15)" insert "ninety (90)".
Page 5-lines 15 and 16 Delete and renumber.
Page 5-line 18 Delete "(c)" insert "(b)".
Page 6-line 23 Delete through "under" insert "alleged violations of".
Page 7-lines 4 through 21 Delete and insert:
"(b) Any employee, contractor or agent of a person being investigated for a violation of W.S. 42‑4‑303(a) shall be entitled to recover all economic damages suffered if that employee, contractor or agent is discharged, demoted, suspended, threatened, harassed or in any other manner retaliated against in the terms and conditions of employment because of lawful acts taken in good faith by the employee or others in an action reported, filed or investigated under this act. An action by an employee, contractor or agent under this subsection shall not be brought more than three (3) years after the date when the retaliation occurred. A person may bring an action in the appropriate district court for the relief provided in this section. This section shall not otherwise be construed to create a private cause of action for violations of this act and is limited to the remedies expressly created by this section related to employment retaliation.".
Page 8-line 4 Delete "this act" insert "subsection (b) of this section".
Page 9-lines 23 and 24 Delete and renumber.
Page 10-line 2 Delete "(c)" insert "(b)". SCOTT, CHAIRMAN
SF0083SS001.02/FAILED (CORRECTED COPY)
[DIVIDED AMENDMENT]
Page 11-line 10 After "person" insert "who is not a licensed physician under chapter 26, title 33 of the Wyoming statutes".
Page 11-after line 24 Insert:
"(f) A person who is a licensed physician under chapter 26, title 33 of the Wyoming statutes who intentionally or knowingly fails to maintain documentary records in accordance with the Medicaid program rules and requirements for medical assistance applicable to the provider is guilty of:
(i) A felony punishable by a fine of not more than ten thousand dollars ($10,000.00), imprisonment for not more than ten (10) years, or both, if the value of related Medicaid medical assistance is ten thousand dollars ($10,000.00) or more;
(ii) A misdemeanor punishable by a fine of not more than seven hundred fifty dollars ($750.00), imprisonment for not more than six (6) months, or both, if the value of related Medicaid medical assistance is less than ten thousand dollars ($10,000.00).". SCOTT, CHAIRMAN
SF0083SW001/ADOPTED
Page 11-lines 10 through 24 Delete, including the Senate Standing Committee amendment (SF0083SS001/A) to these lines and insert:
"(e) A person who fails to maintain records in accordance with Medicaid program rules and requirements for medical assistance is guilty of:
(i) A felony punishable by imprisonment for not more than ten (10) years, a fine of not more than ten thousand dollars ($10,000.00), or both, if the medical assistance claimed for which records were not maintained equals twenty-five percent (25%) or more of the Medicaid claims submitted by the person in the same three (3) month period;
(ii) A misdemeanor punishable by imprisonment for not more than six (6) months, a fine of not more than seven hundred fifty dollars ($750.00), or both, if the medical assistance claimed for which records were not maintained equals more than ten percent (10%) but less than twenty-five percent (25%) of the Medicaid claims submitted by the person in the same three (3) month period.". NUTTING, PETERSON
1/21/2013 S Passed CoW
SF0083S2001/FAILED
Page 11-lines 10 through 24 In the Nutting Committee of the Whole Amendment (SF0083SW001/A) to these lines, in paragraph (e)(i) created by that amendment, delete "felony punishable by imprisonment for not more than ten (10) years" insert "high misdemeanor punishable by imprisonment for not more than one (1) year". ROTHFUSS
1/22/2013 S Passed 2nd Reading
SF0083S3001/ADOPTED
Page 11-lines 10 through 24 Delete, including the Nutting Committee of the Whole Amendment (SF0083SW001/A) to these lines and insert:
"(e) It is unlawful for a person to knowingly fail to maintain records in accordance with Medicaid program rules as necessary to disclose fully the nature of the goods, services, items, facilities or accommodations for which a claim was submitted or payment was received under the Medicaid program. Any person who violates this subsection is guilty of:
(i) A misdemeanor punishable by imprisonment for not more than six (6) months, a fine of not more than seven hundred fifty dollars ($750.00), or both, if the medical assistance claimed for which records were not maintained equals less than twenty-five percent (25%) of the Medicaid claims submitted by that person in a three (3) month period that includes the date on which the claim was submitted;
(ii) A misdemeanor punishable by imprisonment for not more than one (1) year, a fine of not more than five thousand dollars ($5000.00), or both, if the medical assistance claimed for which records were not maintained equals twenty-five percent (25%) or more of the Medicaid claims submitted by that person in a three (3) month period that includes the date on which the claim was submitted;
(iii) A felony punishable by imprisonment for not more than ten (10) years, a fine of not more than ten thousand dollars ($10,000.00), or both, if:
(A) The person intended to defraud and the medical assistance claimed for which records were not maintained equals twenty-five percent (25%) or more of the Medicaid claims submitted by that person in a three (3) month period that includes the date on which the claim was submitted; or
(B) The conviction is the person's second offense within a three (3) year period under this subsection.". ROTHFUSS, PETERSON
1/23/2013 S Passed 3rd Reading
ROLL CALL
Ayes: Senator(s) Anderson, JD S02, Anderson, JL S28, Barnard, Bebout, Burns, Case, Christensen, Coe, Cooper, Craft, Dockstader, Driskill, Emerich, Esquibel, F., Geis, Hastert, Hicks, Hines, Johnson, Landen, Meier, Nicholas, P., Nutting, Perkins, Peterson, Ross, Rothfuss, Schiffer, Scott and Von Flatern
Ayes 30 Nays 0 Excused 0 Absent 0 Conflicts 0
1/24/2013 H Received for Introduction
1/25/2013 H Introduced and Referred to H10
2/12/2013 H10 Recommended Do Pass
ROLL CALL
Ayes: Representative(s) Coleman, Filer, Greene, Harvey, Kasperik, Larsen, Throne and Wilson
Nays: Representative(s) Barlow
Ayes 8 Nays 1 Excused 0 Absent 0 Conflicts 0
2/12/2013 H Placed on General File
2/20/2013 H Passed CoW
SF0083H2001/ADOPTED (TO ENGROSSED COPY)
Page 1-line 3 Delete "prescribing" insert "providing".
Page 1-line 4 After "general" insert "and district attorneys".
Page 1-line 5 After "act;" insert "providing for admissibility of verdicts as specified;".
Page 4-line 7 After "(a)" insert "Except as provided in subsection (c) of this section,".
Page 6-After line 12 Insert:
"(c) The provisions of subsections (a) and (b) of this section shall not apply to a recipient as defined by W.S. 42‑1‑101(a)(v). Any recipient who knowingly:
(i) Presents or causes to be presented a false or fraudulent claim shall be liable to the state for the amount of damages which the state sustains because of the claim and shall be liable for a civil penalty of not more than one thousand dollars ($1,000.00);
(ii) Violates paragraph (i) of this subsection a second or subsequent time shall be liable to the state for three (3) times the amount of damages which the state sustains because of the claim and shall be liable for a civil penalty of not more than one thousand dollars ($1,000.00).".
Page 6-line 14 Delete "Attorney General".
Page 6-line 18 Delete "shall diligently" insert "or a district attorney may".
Page 6-line 19 After "(a)" insert "and (c)".
Page 6-line 20 After "general" insert "or district attorney".
Page 6-line 21 After "(a)" insert "or (c)"; after "general" insert "or district attorney".
Page 7-line 14 Delete the first "section" insert "subsection"; delete the second "section" insert "subsection".
Page 7-line 17 Delete "section" insert "subsection".
Page 7-line 21 After "business" insert "." delete balance of the line.
Page 7-line 22 Delete entirely.
Page 8-line 19 Delete "ten (10)" insert "seven (7)".
Page 8-line 22 Delete "42‑4‑304" insert "42‑4‑304(a)".
Page 9-line 1 Delete "a preponderance" insert "clear and convincing evidence.".
Page 9-line 2 Delete entirely.
Page 9–line 6 After "fraud" delete balance of the line insert "is admissible in any civil".
Page 9–lines 7 and 8 Delete entirely.
Page 9-line 9 Delete "the offense in any". NICHOLAS, B.
SF0083H2002/ADOPTED (TO ENGROSSED COPY)
Page 2-line 17 After "state" insert "or a political subdivision of the state".
Page 4-line 13 Delete "of those"; after "damages" insert "provided in this subsection". GREENE
SF0083H2003/WITHDRAWN
2/21/2013 H Passed 2nd Reading
SF0083H3001/ADOPTED (TO ENGROSSED COPY)
Page 2-line 22 Delete ":".
Page 3-line 1 Delete "(I)".
Page 3-line 2 Delete "; or" insert ".".
Page 3-lines 4 through 23 Delete entirely and insert:
"(ii) "Material statement" means a statement that affects the payment or receipt of money or property.".
Page 4-line 1 Delete "(iv)" insert "(iii)".
Page 5-line 24 Delete "thirty (30)" insert "forty-five (45)".
Page 6-line 1 After "after" delete balance of the line and insert "the information is requested; and".
Page 6-line 2 Delete entirely.
Page 6-line 4 Delete "fully" insert "has".
Page 6-line 5 Delete ";" insert ".".
Page 6-lines 7 through 12 Delete entirely. NICHOLAS, B.
SF0083H3002/FAILED (TO ENGROSSED COPY)
Page 4-line 8 Delete "shall" insert "may".
Page 4-line 9 After "for" insert "up to".
Page 4-line 11 Delete "shall" insert "may".
Page 4-line 14 Delete "shall" insert "may".
Page 4-line 15 Delete line through "not".
Page 4-line 16 Delete "ten thousand dollars ($10,000.00)" insert "five thousand dollars ($5,000.00)".
Page 6-after line 12 Delete the Nicholas second reading amendment (SF0083H2001/AE) to this line and insert:
"(c) The provisions of subsections (a) and (b) of this section shall not apply to a recipient as defined by W.S. 42‑1‑101(a)(v). Any recipient who knowingly:
(i) Presents or causes to be presented a false or fraudulent claim may be liable to the state for the amount of damages which the state sustains because of the claim and may be liable for a civil penalty of not more than one thousand dollars ($1,000.00);
(ii) Violates paragraph (i) of this subsection a second or subsequent time may be liable to the state for three (3) times the amount of damages which the state sustains because of the claim and may be liable for a civil penalty of not more than one thousand dollars ($1,000.00).". NICHOLAS, B.
SF0083H3003.01/ADOPTED (CORRECTED COPY) (TO ENGROSSED COPY)
[DIVIDED AMENDMENT]
Page 7-lines 19 through 22 Delete entirely including the Nicholas second reading amendment (SF0083H2001/AE) to these lines and insert:
"(c) Any action under this act shall be brought in the district court of the county in which the defendant resides. If the defendant is not a resident of the state of Wyoming, the action shall be brought in the First Judicial District Court in Laramie County, Wyoming.". NICHOLAS, B.
SF0083H3003.02/FAILED (CORRECTED COPY) (TO ENGROSSED COPY)
[DIVIDED AMENDMENT]
Page 1-line 7 Delete "creating a cause of action for".
Page 1-line 8 Delete "retaliatory employment actions;".
Page 7-lines 1 through 17 Delete entirely including the Nicholas second reading amendment (SF0083H2001/AE) to these lines and insert:
Page 8-line 1 Delete entirely.
Page 8-line 2 Delete "section" insert "(c)".
Page 8-line 5 Delete "(e)" insert "(d)". NICHOLAS, B.
SF0083H3004.01/ADOPTED (CORRECTED COPY) (TO ENGROSSED COPY)
[DIVIDED AMENDMENT]
Page 11-line 14 Delete "six (6) months" insert "thirty (30) days".
Page 11-line 15 After "if" insert ": (A)".
Page 11-line 17 Delete "equals" insert "is".
Page 11-line 18 Delete "a" insert "any consecutive"; after "period" insert "; and".
Page 11-line 19 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least five thousand dollars ($5,000.00);".
Page 11-line 22 Delete "one (1) year" insert "six (6) months".
Page 11-line 23 Delete "five thousand dollars ($5,000.00)" insert "one thousand dollars ($1,000.00)"; after "if" insert ": (A)".
Page 12-line 1 Delete "equals" insert "is".
Page 12-line 2 Delete "a" insert "any consecutive"; after "period" insert "; and".
Page 12-line 3 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least five thousand dollars ($5,000.00);".
Page 12-line 6 Delete "ten (10)" insert "five (5)".
Page 12-line 11 Delete "equals" insert "is".
Page 12-line 12 Delete "a" insert "any consecutive".
Page 12-line 13 After "period" delete balance of the line.
Page 12-line 14 Delete "submitted"; delete "or" insert "and". NICHOLAS, B.
SF0083H3004.02/FAILED (CORRECTED COPY) (TO ENGROSSED COPY)
[DIVIDED AMENDMENT]
Page 12-lines 16 through 18 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least ten thousand dollars ($10,000.00).". NICHOLAS, B.
2/22/2013 H Passed 3rd Reading
ROLL CALL
Ayes: Representative(s) Baker, Barlow, Berger, Blake, Blevins, Blikre, Brown, Burkhart, Byrd, Campbell, Cannady, Coleman, Connolly, Eklund, Esquibel, K., Filer, Freeman, Gay, Goggles, Greear, Greene, Harshman, Harvey, Hunt, Jaggi, Kasperik, Kirkbride, Krone, Lockhart, Madden, Moniz, Nicholas, B., Northrup, Patton, Paxton, Petroff, Piiparinen, Semlek, Sommers, Stubson, Teeters, Throne, Wallis, Wilson, Winters, Zwonitzer, Dn. and Zwonitzer, Dv.
Nays: Representative(s) Gingery, Halverson, Hutchings, Kroeker, Larsen, Loucks, Lubnau, McKim, Miller, Reeder, Walters and Watt
Excused: Representative(s) Davison
Ayes 47 Nays 12 Excused 1 Absent 0 Conflicts 0
2/22/2013 S Received for Concurrence
2/25/2013 S Did Not Concur
ROLL CALL
Ayes: Senator(s) Meier
Nays: Senator(s) Anderson, JD S02, Anderson, JL S28, Barnard, Bebout, Burns, Case, Christensen, Coe, Cooper, Craft, Dockstader, Driskill, Emerich, Esquibel, F., Geis, Hastert, Hicks, Hines, Johnson, Landen, Nutting, Perkins, Peterson, Ross, Rothfuss, Schiffer, Scott and Von Flatern
Excused: Senator(s) Nicholas, P.
Ayes 1 Nays 28 Excused 1 Absent 0 Conflicts 0
2/25/2013 S Appointed JCC01 Members:
Senator(s) Peterson, Perkins, Schiffer
2/25/2013 H Appointed JCC01 Members:
Representative(s) Nicholas, B., Harvey, Larsen
2/26/2013 S Adopted SF0083JC01
SF0083JC01/A ADOPTED (TO ENGROSSED COPY)
Adopt the following House amendments:
SF0083H2001/AE
SF0083H2002/A
SF0083H3001/AE
Delete the following House amendments:
SF0083H3003.01/ACE
SF0083H3004.01/ACE
Further amend the ENGROSSED COPY as follows:
Page 6-line 4 After the Nicholas, B. House third reading amendment (SF0083H3001/AE) to this line and before "cooperated" insert "substantially".
Page 7-line 19 After "(c)" insert "Except as provided in subsection (b) of this section,".
Page 7-line 21 After "resides" delete "or transacts business" insert ". If the defendant is not a resident of the state of Wyoming, the action shall be brought in the first judicial district court in Laramie County".
Page 11-line 14 Delete "six (6) months" insert "thirty (30) days".
Page 11-line 15 After "if" insert ": (A)".
Page 11-line 17 Delete "equals" insert "is".
Page 11-line 18 Delete "a" insert "any consecutive"; after "period" insert "; and".
Page 11-line 19 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least five thousand dollars ($5,000.00).".
Page 11-line 22 Delete "one (1) year" insert "six (6) months".
Page 11-line 23 Delete "five thousand dollars ($5,000.00)" insert "one thousand dollars ($1,000.00)"; after "if" insert ": (A)".
Page 12-line 1 Delete "equals" insert "is".
Page 12-line 2 Delete "a" insert "any consecutive"; after "period" insert "; and".
Page 12-line 3 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least five thousand dollars ($5,000.00).".
Page 12-line 6 Delete "ten (10)" insert "five (5)".
Page 12-line 11 Delete "equals" insert "is".
Page 12-line 12 Delete "a" insert "any consecutive".
Page 12-line 13 After "period" delete balance of the line and insert "; and".
Page 12-lines 14 through 18 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is more than five thousand dollars ($5,000.00).".PETERSON, PERKINS, SCHIFFER, NICHOLAS, B., HARVEY, LARSEN.
ROLL CALL
Ayes: Senator(s) Anderson, JD S02, Anderson, JL S28, Barnard, Bebout, Case, Christensen, Coe, Cooper, Craft, Dockstader, Driskill, Emerich, Esquibel, F., Geis, Hastert, Hicks, Hines, Johnson, Landen, Meier, Nicholas, P., Nutting, Perkins, Peterson, Ross, Rothfuss, Schiffer, Scott and Von Flatern
Excused: Senator(s) Burns
Ayes 29 Nays 0 Excused 1 Absent 0 Conflicts 0
2/27/2013 H Adopted SF0083JC01
SF0083JC01/AA ADOPTED (TO ENGROSSED COPY)
Adopt the following House amendments:
SF0083H2001/AE
SF0083H2002/A
SF0083H3001/AE
Delete the following House amendments:
SF0083H3003.01/ACE
SF0083H3004.01/ACE
Further amend the ENGROSSED COPY as follows:
Page 6-line 4 After the Nicholas, B. House third reading amendment (SF0083H3001/AE) to this line and before "cooperated" insert "substantially".
Page 7-line 19 After "(c)" insert "Except as provided in subsection (b) of this section,".
Page 7-line 21 After "resides" delete "or transacts business" insert ". If the defendant is not a resident of the state of Wyoming, the action shall be brought in the first judicial district court in Laramie County".
Page 11-line 14 Delete "six (6) months" insert "thirty (30) days".
Page 11-line 15 After "if" insert ": (A)".
Page 11-line 17 Delete "equals" insert "is".
Page 11-line 18 Delete "a" insert "any consecutive"; after "period" insert "; and".
Page 11-line 19 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least five thousand dollars ($5,000.00).".
Page 11-line 22 Delete "one (1) year" insert "six (6) months".
Page 11-line 23 Delete "five thousand dollars ($5,000.00)" insert "one thousand dollars ($1,000.00)"; after "if" insert ": (A)".
Page 12-line 1 Delete "equals" insert "is".
Page 12-line 2 Delete "a" insert "any consecutive"; after "period" insert "; and".
Page 12-line 3 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is at least five thousand dollars ($5,000.00).".
Page 12-line 6 Delete "ten (10)" insert "five (5)".
Page 12-line 11 Delete "equals" insert "is".
Page 12-line 12 Delete "a" insert "any consecutive".
Page 12-line 13 After "period" delete balance of the line and insert "; and".
Page 12-lines 14 through 18 Delete entirely and insert:
"(B) The value of the claims for which the records were not maintained is more than five thousand dollars ($5,000.00).".PETERSON, PERKINS, SCHIFFER, NICHOLAS, B., HARVEY, LARSEN.
ROLL CALL
Ayes: Representative(s) Baker, Barlow, Berger, Blake, Blevins, Blikre, Brown, Burkhart, Byrd, Campbell, Cannady, Coleman, Connolly, Davison, Eklund, Esquibel, K., Filer, Freeman, Gay, Gingery, Goggles, Greear, Greene, Halverson, Harshman, Harvey, Hunt, Hutchings, Jaggi, Kasperik, Kirkbride, Kroeker, Krone, Larsen, Lockhart, Loucks, Madden, McKim, Miller, Moniz, Nicholas, B., Northrup, Patton, Paxton, Petroff, Piiparinen, Reeder, Semlek, Sommers, Stubson, Teeters, Throne, Wallis, Watt, Wilson, Winters, Zwonitzer, Dn. and Zwonitzer, Dv.
Nays: Representative(s) Lubnau and Walters
Ayes 58 Nays 2 Excused 0 Absent 0 Conflicts 0
2/27/2013 Assigned Number SEA No. 0084
2/27/2013 S President Signed SEA No. 0084
2/27/2013 H Speaker Signed SEA No. 0084
3/1/2013 Governor Signed SEA No. 0084
3/1/2013 Assigned Chapter Number
Chapter No. 0118 Session Laws of Wyoming 2013