AB942: Bill Text

AB942,6,18 (3) Monitoring and auditing of providers. The office of the inspector general shall monitor and audit providers to identify and prevent fraud, waste, and abuse, including by doing all of the following

AB942,6,20 (a) Auditing providers of services under Medical Assistance to ensure compliance with Medical Assistance law and rules.

AB942,6,21 (b) Investigating allegations of fraud, waste, and abuse.

AB942,6,23 (c) Providing education and technical assistance to providers through audit activities.

AB942,6,24 (d) Reviewing, tracking, and researching provider billing.

AB942,7,2 (e) Conducting on-site visits to high-risk providers before Medical Assistance program certification.

AB942,7,4 (f) Educating providers and beneficiaries about Medical Assistance program law and rules.

AB942,7,6 (g) Ensuring contracts with providers contain language that helps prevent fraud, waste, and abuse.

AB942,7,8 (h) Ensuring the claims processing system has edit and audit procedures in place to prevent medically unlikely claims.

AB942,7,9 (i) Suspending provider payments when there are credible allegations of fraud.

AB942,7,11 (j) Conducting audits and reviews of providers for compliance with Medical Assistance laws and rules.

AB942,7,13 (k) Issuing explanations of benefits to recipients of Medical Assistance to assist in reporting of fraudulent claims.

AB942,7,15 (L) Providing notices of remittance to providers for review of payments for possible errors.

AB942,7,18 (4) Tracking retailer and recipient fraud. The office of the inspector general shall investigate and track retailer and public assistance recipient fraud including by doing all of the following:

AB942,7,21 (a) Comparing public information, such as social security, state wage records, unemployment benefits, and prisoner data with data provided by the applicant or recipient for public assistance.

AB942,7,24 (b) Conducting monitoring visits, audits, and undercover investigations of retailers who sell items to food stamp program recipients and other public assistance program recipients.

AB942,8,2 (c) Monitoring the number of replacement electronic benefit transfer cards or other indicia of enrollment issued to each recipient.

AB942,8,4 (d) Monitoring social media Internet sites for advertisements of electronic benefit transfer cards or other means of selling food stamp program benefits.

AB942,8,5 (e) Using data analytics to identify patterns indicating fraud.

AB942,8,7 (5) Reporting fraud. The office of the inspector general shall do all of the following:

AB942,8,13 (a) Forward cases of alleged fraud to the appropriate federal, state, and local officials for prosecution, including the Medicaid fraud control unit of the department of justice. The office of the inspector general shall cooperate with any investigation of the Medicaid fraud control unit or other unit of the department of justice into fraudulent activity in any public assistance program administered by the department.

AB942,8,23 (b) Operate and maintain a telephone hotline and online portal to report suspected fraud, waste, and abuse related to public assistance programs and investigate suspected fraud, waste, and abuse that has been reported to the hotline or portal. The office of the inspector general shall coordinate with the legislative audit bureau to ensure that the office of the inspector general is notified of reports of fraud, waste, and abuse related to public assistance programs that are reported to the legislative audit bureau. The office of the inspector general shall forward to any appropriate agency or entity any reports to the hotline or portal of suspected fraud, waste, or abuse that are unrelated to the types of fraud, waste, and abuse investigated by the office of the inspector general.

AB942,9,3 (c) Annually submit to the legislature under s. 13.172 (2) a report summarizing the accomplishments in preventing and stopping fraud in public assistance programs within the department and across the state. The report under this paragraph shall include outcomes on recoupment of overpayments and the number of instances of fraud, waste, or abuse referred for prosecution.

AB942,9,4 (d) Publicly display on an Internet site monthly findings on all of the following:

AB942,9,5 1. Complaint activity to the fraud, waste, and abuse hotline and online portal.

AB942,9,8 2. Fraud prevention activities related to food stamp program and Medical Assistance program recipients, including projected cost avoidance and amounts of overpayments.

AB942,9,9 3. Statewide fraud prevention and investigation.

AB942,9,10 4. Fraud prevent activities related to Medical Assistance program providers.

AB942,9,11 5. Interstate matching activity.

AB942,9,13 6. Fraud prevention activities related to the Women, Infants, and Children program vendors.

AB942,9,16 (e) Publicly display any internal policies or guidance of the office of the inspector general on its process of reviewing and investigating fraud, waste, and abuse and include a display of any updates to the policies or guidance as applicable.

AB942,9,21 (6) Requests for information. Upon request of the office of the inspector general for information relevant to an investigation of fraud, waste, or abuse in a public assistance program, any state agency that receives such a request shall cooperate with the office of the inspector general by providing any information in its possession responsive to that request.

AB942,9,22 (End)