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A bill meant to root out fraud in the state’s Medicaid program is headed for the Senate, but faces an uncertain future after the House added an amendment widening the bill’s focus.

The House voted 76-46 on Wednesday to approve House Bill 1090, known as the Medicaid and Human Services Transparency and Fraud Prevention Act. It attempts to identify fraud and waste in Medicaid and at the Department of Human Services by integrating the departments’ computer systems.

House members had worked with representatives from Medicaid and the Department of Human Services for more than a year on the legislation. Neither agency has voiced opposition to the bill.

In the original legislation brought to the House floor fraud committed by Medicaid beneficiaries was the target. That fact brought criticism from Democrats, including Rep. Omeria Scott, D-Laurel, who argued that the state was potentially overlooking millions in savings by not aiming fraud reduction efforts at providers as well as beneficiaries.

“Why is it that you’re only addressing the beneficiary side when most of the fraud is found on the provider side? Should we not include in this bill the providers so these third-party vendors can locate all the fraud, waste, and abuse?” asked Scott. She offered an amendment that passed to broaden the scope of the bill to include providers.

Rep. Chris Brown, R-Nettleton, who chairs the House Medicaid Committee and authored the legislation, acknowledged that provider fraud is a significant issue. He said the bill didn’t target providers because a report commissioned by the legislature had focused on beneficiaries.

“But I think (this amendment) is part of the process. It’s got to work its way through the Senate now, but I think we’re sending them a good product,” Brown said.

Rep. Joey Hood, R-Ackerman, expressed concern that such a drastic change so late in the legislative process might derail the bill.

“I appreciate her passion in wanting to find more efficient fraud and waste in the system, but I do know that this bill is something we’ve worked on the last three years, and the Department of Human Services has had input in this, too,” Hood said.

“There is already going to be an element of this bill that checks on provider fraud. Can we do more? Certainly we can. But I would ask you to oppose the amendment,” Hood said. “I don’t want to have anything that would bring the bill to a point of order or increase costs to the (Division) of Medicaid.”

Throughout the debate, legislators on both sides of the aisle agreed that finding savings in Medicaid’s $1 billion budget should be a priority.

Last month, the Medicaid Department, which has shouldered two mid-year budget cuts, made a $75 million deficit appropriation request. The Department of Human Services, which has an annual budget of approximately $60 million, received much less attention in the debate.

In committee, earlier in the week, other Democrats said the bill could result in fewer people receiving Medicaid benefits. Hood addressed those concerns when defending the bill on the House floor Tuesday, saying that the program is not targeting people already on the rolls.

“It’s just an eligibility check system,” Hood said.

“So if we want to save money and keep this fraud from escalating … I believe that this third-party vendor will be able to root even more of this out and we’ll be able to save even more money and address some of the deficits we have going forward,” Hood said. “We should be paying people if they’re doing what they say they’re doing. We shouldn’t be paying liars, thieves and hypocrites.”


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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.

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