Senators Aguilar and Smallwood, co-prime sponsors, presented House Bill 18-1211. The bill establishes the Medicaid Fraud Control Unit (MFCU) in the Department of Law (DOL) in statute, and defines Medicaid fraud as a crime. It requires the Department of Health Care Policy and Financing (HCPF), the Department of Public Health and Environment, and managed care organizations and their contractors to report cases of suspected Medicaid fraud to the MFCU. The bill gives HCPF the authority to add the contact information and detail on the MFCU process to the explanation of benefits provided to clients.
Under this bill, the MFCU has the authority to investigate and pursue civil and criminal actions and proceedings. The bill lists the activities that constitute Medicaid fraud and waste, and outlines the penalties associated with each activity. Additionally, the bill clarifies that it is unlawful to knowingly offer, pay, solicit, or receive any remuneration in return for referrals or the purchasing, leasing, ordering or arranging of any good, facility, service, or item for which payment can be made pursuant to the Colorado Medical Assistance Act.
Senator Aguilar provided a handout to the committee [Attachement F].