Medicaid fraud recovery.

WORKING DRAFT
2012
STATE OF
WYOMING
12LSO-0217.E1

SENATE FILE
NO.
SF0081

Medicaid fraud recovery.

Sponsored by:
Senator(s) Peterson and Dockstader and Representative(s) Greene, Harvey and Miller

A BILL

for

AN ACT relating to Medicaid; creating the Wyoming Medicaid False Claims Act; authorizing civil recoveries for the state as specified; prescribing duties of the attorney general; providing procedures; providing for a limitations period and applicability of the act; providing definitions; prescribing criminal penalties as specified for failure to maintain required records; creating a cause of action for retaliatory employment actions; and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.

W.S. 42
‑
4
‑
301 through
42
‑
4
‑
306
are created to read:

ARTICLE 3
FALSE MEDICAID CLAIMS

42
‑
4
‑
301.

Short title.

This act shall be known and may be cited as the "Wyoming Medicaid False Claims Act."

42
‑
4
‑
302.

Definitions.

(a)

As used in this act:

(i)

"Claim" means any request or demand under the Medicaid program, whether under a contract or otherwise, for money
,
property
or services
that:

(A)

Is presented to an officer, employee or agent of the
state
; or

(B)

Is made to a contractor, grantee or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state:

(I)

Provides or has provided any portion of the money or property requested or demanded; or

(II)

Will reimburse the contractor, grantee or other recipient for any portion of the money or property which is requested or demanded
.

(ii)

"Knowing" and "knowingly" mean that a person, with respect to information, and with or without specific intent to defraud:

(
A
)

Has actual knowledge of the information
;

(
B
)

Acts in deliberate ignorance of the truth or falsity of the information
; or

(
C
)

Acts in reckless disregard of the truth or falsity of the information.

(iii)

"Material" means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property;

(
i
v)

"This act" means W.S. 42
‑
4
‑
301 through 42
‑
4
‑
306.

42
‑
4
‑
303.

Acts subjecting person to treble damages; costs and civil penalties; exceptions.

(a)

Any person who commits any of the following acts
in relation to the Wyoming Medical Assistance and Services Act
shall be liable to the
state
for three
(3)
times the amount of damages which the
state
sustains because of the act of that person. A person who commits any of the following acts shall also be liable to the
state
for the costs of a civil action brought to recover any of those penalties or damages, and shall be liable to the
state
for a civil penalty of not less than
one thousand dollars (
$
1
,000
.00)
and not more than
ten thousand dollars (
$10,000
.00)
for each violation:

(
i
)

Knowingly presents or causes to be presented a false or

fraudulent claim for payment or approval
;

(
ii
)

Knowingly makes
,
uses
or
causes to be made or used,

a false record or statement
material to a false or fraudulent claim;

(
i
ii
)

I
s a beneficiary of an inadvertent submission of a false claim to any employee, officer or agent of the state or
a
political subdivision
of the state
, or to any contractor, grantee or other recipient of state funds or funds of any political subdivision
of the state
, who subsequently discovers the falsity of the claim and fails to disclose the false claim and make satisfactory arrangements for repayment to the state or affected political subdivision within
ninety (90) days
after discovery of the false claim
;

(iv)

Conspires to commit a violation of paragraph (i), (ii) or (iii) of this subsection.

(
b
)

Notwithstanding sub
section
(a)
of this section
, the

court may assess not
more
than two
(2)
times the amount of damages

which the
state
sustains because of the act of
a violation of subsection (a) of this section
, and no civil penalty, if the court

finds all of the following:

(
i
)

The person committing the violation furnished

officials of the
state
who are responsible for investigating

false claims violations with all information known to that

person about the violation within
thirty (
30
)
days after the date on

which the person
first obtained the information;

(
ii
)

The person fully cooperated with any investigation by
the state;

(
iii
)

At the time the person furnished the
state
with

information about the violation, no criminal prosecution,

civil action
or
administrative action had commenced with

respect to the violation and the person did not have actual

knowledge of the existence of an investigation into the
violation.

42
‑
4
‑
304.

Attorney general investigations and prosecutions; powers of prosecuting authority; remedies for retaliation; venue; no private right of action.

(a)

The attorney general shall diligently investigate alleged violation
s
under W.S. 42
‑
4
‑
303(a). If the attorney general finds that a person has violated or is violating W.S. 42
‑
4
‑
303(a), the attorney general may bring
a civil

action under this section against that person.

(b)

Any employee, contractor or agent
of a person being investigated for a violation of W.S. 42
‑
4
‑
303(a)
shall be entitled to
recover all economic losses suffered
if that employee, contractor or agent is discharged, demoted, suspended, threatened, harassed or in any other manner
retaliated
against in the terms and conditions of employment because of lawful acts
taken in good faith
by the employee or others in
an action
reported,
filed or investigated under this act.
An action
by an employee, contractor or agent
under this subsection may not be brought more than three (3) years after the date when the retaliation occurred. A person may bring an action in the appropriate district court for the relief provided in this section. This section shall not otherwise be construed to create a private cause of action for violations of this act and is limited to the remedies expressly created by this section related to employment retaliation.

(c)

Any action under this act may be brought in the district court of any county in which the defendant, or any of them, resides or transacts business or in which any act prohibited by W.S. 42-4-303 occurred.

(d)

Except as provided in
subsection (b) of this section
, nothing in this act shall be construed to create a private cause of action.

42
‑
4
‑
305.

Limitation of actions
;
retroactivity; burden of proof.

(a)

A civil action under
W.S. 42
‑
4
‑
304
may

not be brought more than
six (6)
years after the date on which the

violation was committed
or more than three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, whichever occurs last, provided that in no event shall a civil action be brought more than ten (10) years after the date on which the violation is committed
.

(b)

A civil action under this act may be brought for activity prior to the effective date of this act if the limitation period of subsection (a) of this section has not lapsed.

(
c
)

In any action brought under
W.S. 42
‑
4
‑
304
,

the
state
shall be required to prove all

essential elements of the cause of action, including damages, by

a preponderance of the evidence.

(
d
)

Notwithstanding any other provision of law, a

guilty verdict rendered in a criminal proceeding charging false

statements or fraud, whether upon a verdict after trial or upon

a plea of guilty or nolo contender
e
, shall estop the defendant

from denying the essential elements of the offense in any action

which involves the same transaction as in the criminal proceeding

and which is brought under
W.S. 42
‑
4
‑
304
.

42
‑
4
‑
306.

Remedies under other laws; liberality of construction; joint and several liability.

(a)

The provisions of this
act
are
n
ot exclusive, and the remedies provided for in this
act
shall be

in addition to any other remedies provided for in any other law

or available under common law.

(b
)

Liability pursuant to this act is joint and several for any violation done by two (2) or more persons.

Section
2
.

W.S. 42
‑
4
‑
102(a) by creating new paragraphs (xii) and (xiii) and 42
‑
4
‑
111 by creating a new subsection (e) are amended to read:

42
‑
4
‑
102.

Definitions.

(a)

As used in this chapter:

(xii)

"Intentional" means that a person, with respect to information, intended to act in violation of the law;

(xiii)

"Knowing" or "knowingly" includes intentional or intentionally and means that a person, with respect to information, acts:

(A)

With actual knowledge of the information;

(B)

In deliberate ignorance of the truth or falsity of the information; or

(C)

In reckless disregard of the truth or falsity of the information.

42
‑
4
‑
111.

Providing or obtaining assistance by misrepresentation; penalties.

(e)

A person who fails to maintain records in accordance with Medicaid program rules and requirements for medical assistance is guilty of:

(i)

A felony punishable by imprisonment for not more than ten (10) years, a fine of not more than ten thousand dollars ($10,000.00), or both, if the value of related medical assistance is
five hundred
dollars ($
5
00.00) or more;

(ii)

A misdemeanor punishable by imprisonment for not more than six (6) months, a fine of not more than seven hundred fifty dollars ($750.00), or both, if the value of related medical assistance is less than
five hundred
dollars ($
5
00.00).

Section 3.

This act is effective July 1, 2012.

(END)

1
SF0081