House Study Bill 89 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED DEPARTMENT OF INSPECTIONS AND APPEALS BILL) A BILL FOR An Act relating to investigative costs of the Medicaid fraud 1 control unit. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1310DP (4) 84 pf/nh

S.F. _____ H.F. _____ Section 1. Section 249A.7, subsection 3, Code 2011, is 1 amended to read as follows: 2 3. a. A Medicaid fraud account is created in the general 3 fund of the state under the authority of the department of 4 inspections and appeals. Moneys from penalties , investigative 5 costs recouped by the Medicaid fraud control unit, and other 6 amounts received as a result of prosecutions involving the 7 department of inspections and appeals investigations and audits 8 to ensure compliance with the medical assistance program that 9 are not credited to the program may be credited to the account. 10 b. Notwithstanding sections 8.33 and 8.39 , moneys credited 11 to the account shall not revert to any other account or fund 12 and are not subject to transfer except as specifically provided 13 by law. Moneys in the fund shall be used for costs associated 14 with the department of inspections and appeals’ efforts to 15 address medical assistance program fraud and abuse and for 16 costs incurred by the department of inspections and appeals 17 or other agencies in providing regulation, responding to 18 allegations, or other activity involving chapter 135O . 19 c. The department of inspections and appeals and other 20 agencies receiving moneys from the account shall provide a 21 joint annual report to the governor and general assembly 22 detailing the expenditures from the account and activities 23 performed relating to the expenditures. This subsection is 24 repealed on July 1, 2012. 25 d. For the purposes of this subsection, “investigative 26 costs” means the reasonable value of a Medicaid fraud control 27 unit investigator’s, auditor’s, or employee’s time attributable 28 to a particular case, any moneys expended by the Medicaid 29 fraud control unit attributable to a particular case, and the 30 reasonable fair market value of resources used or expended by 31 the Medicaid fraud control unit attributable to a particular 32 case. 33 Sec. 2. Section 910.1, subsection 4, Code 2011, is amended 34 to read as follows: 35 -1- LSB 1310DP (4) 84 pf/nh 1/ 4

S.F. _____ H.F. _____ 4. “Restitution” means payment of pecuniary damages to 1 a victim in an amount and in the manner provided by the 2 offender’s plan of restitution. “Restitution” also includes 3 fines, penalties, and surcharges, the contribution of funds to 4 a local anticrime organization which provided assistance to law 5 enforcement in an offender’s case, the payment of crime victim 6 compensation program reimbursements, payment of restitution 7 to public agencies pursuant to section 321J.2, subsection 8 13 , paragraph “b” , court costs including correctional fees 9 approved pursuant to section 356.7 , court-appointed attorney 10 fees ordered pursuant to section 815.9 , including the expense 11 of a public defender, and the performance of a public service 12 by an offender in an amount set by the court when the offender 13 cannot reasonably pay all or part of the court costs including 14 correctional fees approved pursuant to section 356.7 , or 15 court-appointed attorney fees ordered pursuant to section 16 815.9 , including the expense of a public defender , and payment 17 to the medical assistance program pursuant to chapter 249A for 18 expenditures paid on behalf of the victim resulting from the 19 offender’s criminal activities including investigative costs 20 incurred by the Medicaid fraud control unit pursuant to section 21 249A.7 . 22 Sec. 3. Section 910.2, subsection 1, Code 2011, is amended 23 to read as follows: 24 1. In all criminal cases in which there is a plea of guilty, 25 verdict of guilty, or special verdict upon which a judgment 26 of conviction is rendered, the sentencing court shall order 27 that restitution be made by each offender to the victims of 28 the offender’s criminal activities, to the clerk of court for 29 fines, penalties, surcharges, and, to the extent that the 30 offender is reasonably able to pay, for crime victim assistance 31 reimbursement, restitution to public agencies pursuant to 32 section 321J.2, subsection 13 , paragraph “b” , court costs 33 including correctional fees approved pursuant to section 34 356.7 , court-appointed attorney fees ordered pursuant to 35 -2- LSB 1310DP (4) 84 pf/nh 2/ 4

S.F. _____ H.F. _____ section 815.9 , including the expense of a public defender, when 1 applicable, contribution to a local anticrime organization, 2 or restitution to the medical assistance program pursuant to 3 chapter 249A for expenditures paid on behalf of the victim 4 resulting from the offender’s criminal activities . However, 5 victims shall be paid in full before fines, penalties, and 6 surcharges, crime victim compensation program reimbursement, 7 public agencies, court costs including correctional fees 8 approved pursuant to section 356.7 , court-appointed attorney 9 fees ordered pursuant to section 815.9 , including the expenses 10 of a public defender, contributions to a local anticrime 11 organization, or the medical assistance program are paid. In 12 structuring a plan of restitution, the court shall provide 13 for payments in the following order of priority: victim, 14 fines, penalties, and surcharges, crime victim compensation 15 program reimbursement, public agencies, court costs including 16 correctional fees approved pursuant to section 356.7 , 17 court-appointed attorney fees ordered pursuant to section 18 815.9 , including the expense of a public defender, contribution 19 to a local anticrime organization, and the medical assistance 20 program. 21 EXPLANATION 22 This bill relates to investigative costs incurred by 23 the Medicaid fraud control unit. The bill provides that 24 investigative costs recouped by the Medicaid fraud control 25 unit, in addition to penalties and other amounts received as a 26 result of prosecutions to ensure compliance with the medical 27 assistance program that are not credited to the Medicaid 28 program, may be credited to the Medicaid fraud account. The 29 bill defines “investigative costs” as the reasonable value of 30 a Medicaid fraud control unit investigator’s, auditor’s, or 31 employee’s time attributable to a particular case, any moneys 32 expended by the Medicaid fraud control unit attributable to 33 a particular case, and the reasonable fair market value of 34 resources used or expended by the Medicaid fraud control unit 35 -3- LSB 1310DP (4) 84 pf/nh 3/ 4

S.F. _____ H.F. _____ attributable to a particular case. 1 The bill also amends the definition of “restitution” under 2 the restitution chapter (Code chapter 910) to include payment 3 to the medical assistance program for expenditures paid on 4 behalf of the victim resulting from the offender’s criminal 5 activities including investigative costs incurred by the 6 Medicaid fraud control unit. 7 -4- LSB 1310DP (4) 84 pf/nh 4/ 4