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Senator Hilliard pushes Medicaid audit overhaul, bill circled for further review
Summary
Senator Hilliard presented first substitute SB61 to change Medicaid audit practices, proposing auditor training, a ban on contingency fees, and a restriction on extrapolation; he moved to substitute and circle the bill so senators could review the changes before a vote.
Senator Hilliard introduced the first substitute to Senate Bill 61, calling for reforms to how Medicaid audits are conducted and moving to circle the substituted bill for later consideration.
Hilliard said recent audits have produced what he described as problematic outcomes, including an example he cited of a pediatric dentist facing an initial $6,000,000 assessment that Hilliard said was later reduced to about $2,000 on appeal. He said some auditors are paid on contingency and lack appropriate subject-matter competence. "They get paid a contingency fee on whatever problems they can find," Hilliard said, arguing that practice creates perverse incentives.
The substitute as explained by Hilliard would (1) require auditors be trained and competent for the providers they audit, (2) eliminate contingency-fee payment arrangements for auditors, and (3) prohibit extrapolation as a basis for broad fines when audits rely on small samples. Hilliard said the changes reflect input from health-care providers and regulators and that some technical clarifications may follow as he continues to work with staff and stakeholders.
Hilliard moved to delete the original bill text and substitute the first substitute for SB61; the Senate approved the motion to substitute and then approved a motion to circle the substitute so members could review it before a final vote. Hilliard said he did not seek a final vote immediately but intends to return with the item for further consideration.
The action leaves SB61 under consideration with the first substitute officially in place and the Senate "circled" (set aside for review). The bill will return to the calendar for future action after senators have had time to examine the substitute.
