Adopted

AMENDMENT NO 1 PROPOSED TO

Cmte Sub for House Bill No. 1090

BY: Representative Scott

AMEND by inserting the following new subsection (4) after line 102:

     "(4)  (a)  As used in this subsection, the following terms shall be defined as provided in this paragraph:

          (i)  "Abuse" includes any practice that is inconsistent with acceptable fiscal, business or medical practices that unnecessarily increase cost.

          (ii)  "Fraud" means misrepresenting the truth to obtain an unauthorized benefit.

          (b)  The department shall establish and use a computerized system to determine the extent of waste, abuse and fraud in the programs administered by the department, focusing on detecting and preventing abuse and fraud by providers of services in those programs, and recovering improper payments made to providers of services in those programs.  Activities that constitute abuse and fraud by providers include, but are not limited to, any of the following:

              (i)  Billing for a service that was not performed;

              (ii)  Billing for a more costly service than was performed;

              (iii)  Billing for a covered service when a noncovered service was provided;

              (iv)  Duplicate billing for the same service;

              (v)  Falsifying diagnoses; or

              (vi)  Prescribing unnecessary medicines or expensive tests."