1999 Montana Legislature

About Bill -- Links

SENATE BILL NO. 75

INTRODUCED BY M. HALLIGAN

BY REQUEST OF THE DEPARTMENT OF JUSTICE



A BILL FOR AN ACT ENTITLED: "AN ACT GENERALLY REVISING LAWS PROHIBITING FRAUD AND ABUSE IN THE PROVISION OF HEALTH CARE SERVICES; REQUIRING THAT REPORTS OF ABUSE AND NEGLECT BE FILED WITH THE MEDICAID FRAUD CONTROL UNIT; CREATING THE OFFENSE OF MISTREATMENT OF A PATIENT; ESTABLISHING REQUIREMENTS FOR MAINTAINING AND DISCLOSING MEDICAID RECORDS AND PROVIDING PENALTIES FOR FAILURE TO MAINTAIN OR DESTRUCTION OR CONCEALMENT OF MEDICAID RECORDS AUTHORIZING THE MEDICAID FRAUD CONTROL UNIT TO INVESTIGATE COMPLAINTS ABOUT PATIENT ABUSE AND NEGLECT AND MISAPPROPRIATION OF PATIENT PROPERTY BY ANY PERSON; AND AMENDING SECTIONS 52-3-811 AND SECTION 53-6-157, MCA."



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:



     Section 1.  Section 52-3-811, MCA, is amended to read:

     "52-3-811.  Reports. (1) When the professionals and other persons listed in subsection (3) know or have reasonable cause to suspect that an older person or a person with a developmental disability known to them in their professional or official capacities has been subjected to abuse, sexual abuse, neglect, or exploitation, they shall:

     (a)  if the person is not a resident of a long-term care facility, report the matter to:

     (i)  the department of public health and human services or its local affiliate;

     (ii) the county attorney of the county in which the person resides or in which the acts that are the subject of the report occurred;

     (b)  if the person is a resident of a long-term care facility, report the matter to the long-term care ombudsman appointed under the provisions of 42 U.S.C. 3027(a)(12) and to, the department of public health and human services, and the medicaid fraud control unit provided for in 53-6-156. The department shall investigate the matter pursuant to its authority in 50-5-204 and, if it finds any allegations of abuse, sexual abuse, neglect, or exploitation contained in the report to be substantially true, forward a copy of the report to the county attorney as provided in subsection (1)(a)(ii).

     (2)  If the report required in subsection (1) involves an act or omission of the department of public health and human services that may be construed as abuse, sexual abuse, neglect, or exploitation, a copy of the report may not be sent to the department but must be sent instead to the medicaid fraud control unit and the county attorney of the county in which the older person or the person with a developmental disability resides or in which the acts that are the subject of the report occurred.

     (3)  Professionals and other persons required to report are:

     (a)  a physician, resident, intern, professional or practical nurse, physician's assistant, or member of a hospital staff engaged in the admission, examination, care, or treatment of persons;

     (b)  an osteopath, dentist, denturist, chiropractor, optometrist, podiatrist, medical examiner, coroner, or any other health or mental health professional;

     (c)  an ambulance attendant;

     (d)  a social worker or other employee of the state, a county, or a municipality assisting an older person or a person with a developmental disability in the application for or receipt of public assistance payments or services;

     (e)  a person who maintains or is employed by a roominghouse, retirement home, nursing home, group home, or adult foster care home;

     (f)  an attorney, unless the attorney acquired knowledge of the facts required to be reported from a client and the attorney-client privilege applies;

     (g)  a peace officer or other law enforcement official; and

     (h)  a person providing services to an older person or a person with a developmental disability pursuant to a contract with a state or federal agency.

     (4)  Any other person may submit a report as provided in subsection (1)."



     Section 1.  Section 53-6-157, MCA, is amended to read:

     "53-6-157.  Powers and duties of medicaid fraud control unit. (1) The medicaid fraud control unit shall:

     (a)  investigate and prosecute under applicable criminal statutes fraud and abuse by applicants, recipients, providers, or other persons under the medical assistance program established under this chapter, including but not limited to cases referred by the department;

     (b)  review any complaint of patient abuse, patient neglect, and misappropriation of patient property by providers or their employees or agents and, when appropriate, shall investigate and initiate criminal proceedings or refer the complaint to another federal, state, or local agency for action;

     (c)  refer to the department for collection and, when appropriate, consideration and imposition of appropriate recipient restrictions or provider sanctions cases involving recipient or provider overpayments, fraud, abuse, inappropriate use of services, or other improper activities discovered by the unit in carrying out its activities;

     (d)  communicate and cooperate with and, subject to applicable confidentiality laws, provide information to other state and federal agencies involved in the investigation and prosecution of health care fraud, abuse, and other improper activities related to the medicaid program;

     (e)  transmit to other state and federal agencies, in accordance with law reports of convictions, copies of judgments and sentences imposed and other information and documents for purposes of program exclusions or other sanctions or penalties under medicaid, medicare, or other state or federal benefit or assistance programs; and

     (f)  recommend to state agencies appropriate or necessary adoption or revision of statutes, regulations, rules, policies, and procedures to prevent fraud, abuse, and other improper activities under the medicaid program and to aid in the investigation and prosecution of fraud, abuse, and other improper activities under the medicaid program.

     (2)  The medicaid fraud control unit may:

     (a)  initiate criminal prosecutions related to the medicaid program in any court of competent jurisdiction in the state of Montana;

     (b)  upon written request, obtain information and records from applicants, recipients, and providers;

     (c)  exercise the authority granted to prosecutors with respect to criminal investigative subpoenas under Title 46, chapter 4, part 3;

     (d)  subject to applicable federal confidentiality laws and regulations and for purposes related to any investigation or prosecution related to the medicaid program, obtain from the department, county welfare and human services offices, and other local, county, or state government departments or agencies records and other information, including but not limited to applicant and recipient applications, provider enrollment forms, claims and reports, individual or entity tax returns, or other information provided to or in the possession of the department of revenue or the state auditor;

     (e)  refer appropriate cases to other state or federal agencies for investigation, prosecution, or imposition of penalties, restrictions, or sanctions;

     (f)  enter into agreements with the department and other state and federal agencies in furtherance of the unit's mission; and

     (g)  do all things necessary to comply with 42 U.S.C. 1396a(a)(61) and 42 U.S.C. 1396b(q) and any implementing federal regulations and policies that require the state to operate a medicaid fraud control unit."



     NEW SECTION.  Section 3.  Mistreatment of patient. (1) A person commits the offense of mistreatment of a patient if the person provides care to a patient, for compensation, and purposely or knowingly:

     (a) causes bodily injury to a patient;

     (b) without lawful authority, fails to provide a patient with food, shelter, clothing, or services necessary to maintain the physical or mental health of the patient; or

     (c) uses or takes a patient's money or a patient's property for the advantage of the person or another by means of duress, menace, fraud, deception, or undue influence.

     (2) A person convicted of the offense of mistreatment of a patient shall be imprisoned in a state prison for a term not to exceed 10 years or be fined an amount not to exceed $50,000, or both.

     (3) As used in this section, "patient" means a person who receives treatment from or resides in a hospital; skilled nursing facility; intermediate care facility; care facility for the developmentally disabled; psychiatric facility; rehabilitation facility; kidney disease treatment center; home health agency; ambulatory surgical or outpatient facility; home for the aged or disabled; group home; adult foster care home; private home that provides personal care, sheltered care, or nursing care for one or more persons; adult day-care center; or any other health or resident care-related facility or home, whether publicly or privately owned.



     NEW SECTION.  Section 4.  Maintenance of records -- penalties for failure to maintain, destruction of, or concealment of records. (1) All providers shall maintain the records necessary to fully demonstrate the nature and medical necessity of goods, services, items, facilities, or accommodations for which a claim was submitted or payment was received under the medicaid program or records that are necessary to fully disclose all income and expenditures upon which rates of payment were based under the medicaid program. The records must be maintained for 5 years after the date on which the payment was received or, if payment was not received, for 5 years after the date on which the claim was submitted.

     (2) A person who purposely, knowingly, or negligently fails to maintain the records required under this section for the period prescribed by subsection (1) is guilty of an offense and may be fined an amount not to exceed $500.

     (3) A person who purposely or knowingly destroys or conceals records required to be maintained under this section is guilty of an offense and may be incarcerated for a term not to exceed 1 year or fined an amount not to exceed $1,000, or both.



     NEW SECTION.  Section 5.  Codification instruction. (1) [Section 3] is intended to be codified as an integral part of Title 45, chapter 5, and the provisions of Title 45, chapter 5, apply to [section 3].

     (2) [Section 4] is intended to be codified as an integral part of Title 53, chapter 6, and the provisions of Title 53, chapter 6, apply to [section 4].

- END -




Latest Version of SB 75 (SB0075.02)
Processed for the Web on February 1, 1999 (4:35PM)

New language in a bill appears underlined, deleted material appears stricken.

Sponsor names are handwritten on introduced bills, hence do not appear on the bill until it is reprinted. See the status of this bill for the bill's primary sponsor.

Status of this Bill | 1999 Legislature | Leg. Branch Home
This bill in WP 5.1 | All versions of all bills in WP 5.1

Prepared by Montana Legislative Services
(406)444-3064