Relates to the handling of tips received through the office of the Medicaid inspector general's Medicaid fraud hotline

◆ The sponsor's argument

Why Dean Murray says this is needed

Medicaid is one of New York State's largest and most important public programs. Fraud and abuse within the Medicaid program not only waste taxpayer dollars, but also divert resources from the millions of New Yorkers who rely upon the program for access to health care. Reports of suspected fraud therefore must be handled in a manner that ensures cred- ible allegations receive appropriate review and are promptly brought to the attention of officials with the authority to investigate and prose- cute wrongdoing. The Office of the Medicaid Inspector General maintains a hotline through which suspected Medicaid fraud and abuse may be reported. Unfortunate- ly, the limited resources of the Attorney General and the Office of the Medicaid Inspector General (OMIG) naturally lead them to concentrate on the biggest potential cases, while many smaller cases have to be put on the back burner. These smaller cases, however, could represent substan- tial sums in the aggregate. This legislation strengthens the handling of those reports by establish- ing clear requirements for credible allegations received through the hotline. Once an allegation is determined to be credible, the informa- tion must be shared with the Attorney General's Medicaid Fraud Control Unit and local district attorneys. The legislation also establishes accountability following that referral by requiring a determination within thirty days as to whether an investigation will be conducted and which jurisdiction will lead it, as well as notification to the Medicaid Inspector General of the ultimate outcome. This determination will provide greater opportunities for local district attorneys to pursue cases within their social service districts. In addition, the annual reporting requirement established by this bill will provide policymakers with important information regarding the disposition of Medicaid fraud hotline tips, including how many tips are received and investigated, who conducts those investigations, and their outcomes. This information will help ensure that credible allegations of Medicaid fraud do not simply fall through the cracks and will allow state officials to better evaluate whether the hotline and referral process are functioning effectively. By creating a clear process for the referral, investigation and tracking of credible Medicaid fraud allegations, this legislation will strengthen oversight, improve accountability, and help protect both taxpayers and the integrity of New York's Medicaid program.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.