1.1Senator Abeler moved to amend
S.F. No. 4476 as follows (...):
1.2Page 87, after line 25, insert:
1.3 "Section 1. Minnesota Statutes 2024, section 256B.04, subdivision 5, is amended to read:
1.4 Subd. 5.
Annual report required. The state agency within 60 days after the close of
1.5each fiscal year, shall prepare and print for the fiscal year a report that includes
: a full
1.6account of the operations and expenditure of funds under this chapter
,; a full account of the
1.7activities undertaken in accordance with subdivision 10
,; adequate and complete statistics
1.8divided by counties about all medical assistance provided in accordance with this
chapter
,;
1.9a full account of all pre-enrollment, postenrollment, and unannounced site visits
to providers
1.10under section 256B.044, subdivision 5; and any other information it may deem advisable."
1.11Page 94, after line 11, insert:
1.12 "Sec. 4. Minnesota Statutes 2025 Supplement, section 256B.064, subdivision 1a, is amended
1.13to read:
1.14 Subd. 1a.
Grounds for sanctions. (a) The commissioner may impose sanctions against
1.15any individual or entity that receives payments from medical assistance or provides
goods
1.16or services for which payment is made from medical assistance for any of the following:
1.17(1) fraud, theft, or abuse in connection with the provision of goods and services
to
1.18recipients of public assistance for which payment is made from medical assistance;
1.19(2) a pattern of presentment of false or duplicate claims or claims for services not
1.20medically necessary;
1.21(3) a pattern of making false statements of material facts for the purpose of obtaining
1.22greater compensation than that to which the individual or entity is legally entitled;
1.23(4) suspension or termination as a Medicare vendor;
1.24(5) refusal to grant the state agency access during regular business hours to examine
all
1.25records necessary to disclose the extent of services provided to program recipients
and
1.26appropriateness of claims for payment;
1.27(6) failure to repay an overpayment
provided in section 256B.0641 or a fine finally
1.28established under this section;
1.29(7) failure to correct errors in the maintenance of health service or financial records
for
1.30which a fine was imposed or after issuance of a warning by the commissioner; and
2.1(8) any reason for which an individual or entity could be excluded from participation
in
2.2the Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security
Act.
2.3(b) For the purposes of this section, goods or services for which payment is made
from
2.4medical assistance includes but is not limited to care and services identified in
section
2.5256B.0625 or provided pursuant to any federally approved waiver.
2.6(c) Regardless of the source of payment or other item of value, the commissioner may
2.7impose sanctions against any individual or entity that solicits, receives, pays, or
offers to
2.8pay any illegal remuneration as described in section
142E.51, subdivision 6a, in violation
2.9of section
609.542, subdivision 2, or in violation of United States Code, title 42, section
2.101320a-7b(b)(1) or (2). No conviction is required before the commissioner can impose
2.11sanctions under this paragraph.
2.12(d) The commissioner may impose sanctions against a pharmacy provider for failure
to
2.13respond to a cost of dispensing survey under section
256B.0625, subdivision 13e, paragraph
2.14(g).
2.15(e) The commissioner may impose sanctions against a pharmacy provider for failure
to
2.16respond to a Minnesota drug acquisition cost survey under section
256B.0625, subdivision
2.1713e, paragraph (i).
2.18(f) For the purposes of this section, "abuse" does not include billing errors that
result in
2.19unintended overcharges.
2.20 Sec. 5. Minnesota Statutes 2024, section 256B.064, subdivision 1c, is amended to read:
2.21 Subd. 1c.
Grounds for and methods of monetary recovery. (a) The commissioner
2.22may obtain monetary recovery from an individual or entity
that has been improperly paid
2.23by the department either as a result of conduct described in subdivision 1a or as
a result of
2.24an error by the individual or entity submitting the claim or by the department, regardless
of
2.25whether the error was intentional. Patterns need not be proven as a precondition to
monetary
2.26recovery of erroneous or false claims, duplicate claims, claims for services not medically
2.27necessary, or claims based on false statements for an overpayment as defined in Code of
2.28Federal Regulations, title 42, section 433.304.
2.29(b) The commissioner may obtain monetary recovery using methods including but not
2.30limited to the following: assessing and recovering money improperly paid and debiting
from
2.31future payments any money improperly paid. The commissioner
shall must charge interest
2.32on money to be recovered if the recovery is to be made by installment payments or
debits,
2.33except when the monetary recovery is of an overpayment that resulted from a department
3.1error. The interest charged
shall must be the rate established by the commissioner of revenue
3.2under section
270C.40.
3.3EFFECTIVE DATE.This section is effective the day following final enactment.
3.4 Sec. 6. Minnesota Statutes 2024, section 256B.064, subdivision 1d, is amended to read:
3.5 Subd. 1d.
Investigative costs. (a) The commissioner may seek recovery of investigative
3.6costs from any individual or entity that
willfully submits a claim for reimbursement for
3.7services that the individual or entity knows, or reasonably should have known, is
a false
3.8representation and that results in the payment of public funds for which the individual
or
3.9entity is ineligible violates the False Claims Act pursuant to United States Code, title 31,
3.10section 3729-3733 or section 15C.02.
3.11(b) Billing errors that result in unintentional overcharges
shall are not
be grounds for
3.12investigative cost recoupment.
3.13EFFECTIVE DATE.This section is effective the day following final enactment.
3.14 Sec. 7. Minnesota Statutes 2024, section 256B.064, is amended by adding a subdivision
3.15to read:
3.16 Subd. 2a. Appeal of temporary payment withhold. (a) Upon receipt of a notice under
3.17subdivision 2, paragraph (c), that a payment withhold is imposed, an individual or
entity
3.18may request a review under paragraph (c) by filing with the commissioner a written
request
3.19of appeal. The appeal request must be received by the commissioner no later than 30
days
3.20after the date the notification of the payment withhold was mailed to the individual
or entity.
3.21The appeal request must specify the reason the payment withholding decision is in
error
3.22and clearly request a hearing. The commissioner must refer the appeal request to the
Court
3.23of Administrative Hearings within ten business days of receiving the appeal request.
3.24(b) The cost of the review under paragraph (c) must be paid by the individual or entity.
3.25(c) The burden of proof upon appeal of a temporary withhold is limited to whether
the
3.26commissioner can establish there is a credible allegation of fraud as provided in
subdivision
3.272, paragraph (b), clause (2). The administrative law judge's recommendation to the
3.28commissioner must not make findings on the veracity of the underlying allegations
of fraud,
3.29as the underlying investigation remains ongoing and underlying facts may be litigated
in
3.30future administrative, civil, or criminal proceedings when a final agency decision
is issued.
3.31(d) To protect the integrity of the ongoing investigation, the commissioner must submit
3.32evidence to support the action to the administrative law judge under seal. The individual
or
4.1entity may submit evidence to the administrative law judge that supports the position
of the
4.2individual or entity that the payment withholding decision is in error. The administrative
4.3law judge must review the evidence in camera. The commissioner shall not be subject
to
4.4discovery by the individual or entity during the proceedings.
4.5(e) The commissioner must provide notice to the individual or entity when the
4.6administrative law judge makes a recommendation. The notice must be sent within ten
4.7business days of the administrative law judge's completed recommendation and must
state
4.8that the appeal process under this subdivision is completed.
4.9(f) The administrative law judge's findings of facts, conclusions of law, and
4.10recommendation as to whether there is a credible allegation of fraud, may not be used
or
4.11considered for any other purpose, including impeachment, in any civil, criminal,
4.12administrative, or contractual proceeding. The administrative law judge's findings
of facts,
4.13conclusions of law, and recommendation may not be held conclusive or binding or used
as
4.14evidence in any separate or subsequent action in any other forum, be it contractual,
4.15administrative, or judicial, regardless of whether the action involves the same or
related
4.16parties or involves the same facts."
4.17Renumber the sections in sequence and correct the internal references
4.18Amend the title accordingly
4.19The motion prevailed. #did not prevail. So the amendment was #not adopted.