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2019 SESSION

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19101826D
HOUSE BILL NO. 2015 Offered January 9, 2019 Prefiled January 7, 2019 A BILL to amend and reenact § 32.1-319.1 of the Code of Virginia, relating to Department of Medical Assistance Services; fraud prevention. ---------- Patrons-- Peace and Landes ---------- Referred to Committee on Health, Welfare and Institutions ----------

Be it enacted by the General Assembly of Virginia:

1. That § 32.1-319.1 of the Code of Virginia is amended and reenacted as follows:

§ 32.1-319.1. Department to establish program to use prepayment analytics to mitigate risk of improper payments.

A. The Department shall establish a program using prepayment analytics to mitigate the risk of improper payments to providers of services that are paid through the Department's fee-for-service delivery system furnished under the state plan for medical assistance who commit fraud, abuse, or errors. Such program shall include the use of predictive modeling, provider profiling, trend analysis, and other prepayment analytics to identify providers and claims with a high likelihood of fraud, abuse, or error and prevent payments on potentially fraudulent claims from being made until such claims have been validated.

B. The Department may enter into a contract or agreement with a vendor for the operation of the program to mitigate risk of improper payments to providers of services that are paid through the Department's fee-for-service delivery system furnished under the state plan for medical assistance required by this section.