Medicaid Provider Compliance Billing Safety Rules

The bill subjects a provider of medicaid services to a civil monetary penalty if the provider improperly bills or seeks collection from a medicaid recipient or the estate of a medicaid recipient. The provider is also liable for a refund to the recipient of any amount unlawfully received from the recipient, including statutory interest, and for all amounts submitted to a collection agency in the name of the recipient. If, within 30 days, a provider voids the bill, returns any amounts unlawfully received, and makes every effort to resolve the collection action for the recipient, the provider is not subject to the penalties outlined in the bill. A provider is not subject to the penalties outlined in the bill if a person knowingly misrepresents his or her medicaid coverage status to the provider and the provider submits documentation relating to the misrepresentation. A provider may appeal the imposition of a civil monetary penalty.

In addition, the bill allows the department of health care policy and financing (department) to require a corrective action plan from any provider who fails to comply with rules, manuals, or bulletins issued by the department, the medical services board, or the department's fiscal agent or from a provider whose activities endanger the health, safety, or welfare of a medicaid recipient.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)