SENATE DOCKET, NO. 1500        FILED ON: 1/18/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 555

The Commonwealth of Massachusetts

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PRESENTED BY:

Richard T. Moore

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to reduce health care fraud, waste and abuse.

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PETITION OF:

SENATE DOCKET, NO. 1500        FILED ON: 1/18/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 555

The Commonwealth of Massachusetts

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In the Year Two Thousand Thirteen

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An Act to reduce health care fraud, waste and abuse.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1.  (a) Notwithstanding any general or special law to the contrary, not later than July 31, 2014, the MassHealth program within the executive office of health and human services shall implement provider data verification and provider screening technology, predictive modeling and analytics technologies, clinical code editing technology, or any such technology, strategy or system that is designed to prevent and detect healthcare fraud, waste and abuse in the programs set forth in chapter 118E of the General Laws prior to claims being paid. The executive office shall be exempt from the requirement to such technologies, strategies or systems if it has reported not later than July 31, 2013, to the committee on health care financing, senate and house committees on ways and means and the executive office for administration and finance that using such technologies, strategies or systems would not be cost effective.

(b) Annually, on or before October 1, the executive office of health and human services shall report to the committee on health care financing, senate and house committees on ways and means and the executive office for administration and finance: (1) the current status of implementation or use of any technologies, strategies or systems designed to prevent and detect healthcare fraud, waste and abuse in the programs set forth in chapter 118E; (2) the actual or projected savings to the programs as a result of the implementation or use of such technologies, strategies or systems, including estimates of the amounts of such savings with respect to both improper payments recovered and improper payments avoided; (3) the actual or projected savings to the programs relative to the return on investment as a result of the use of such technologies, strategies or systems; and (4) any further considerations or recommendations relative to the implementation and cost of such technologies, strategies or systems. This report may be integrated into the reporting requirement set forth in section 6 of chapter 118E of the General Laws.