Section 191.909

Title XII PUBLIC HEALTH AND WELFARE

Chapter 191

Effective - 28 Aug 2007, 2 histories, see footnote   (history) 

  191.909.  Reports required, contents. — 1. By January 1, 2008, and annually thereafter, the attorney general's office shall report to the general assembly and the governor the following:

  (1) The number of provider investigations due to allegations of violations under sections 191.900 to 191.910 conducted by the attorney general's office and completed within the reporting year, including the age and type of cases;

  (2) The number of referrals due to allegations of violations under sections 191.900 to 191.910 received by the attorney general's office;

  (3) The total amount of overpayments identified as the result of completed investigations;

  (4) The amount of fines and restitutions ordered to be reimbursed, with a delineation between amounts the provider has been ordered to repay, including whether or not such repayment will be completed in a lump sum payment or installment payments, and any adjustments or deductions ordered to future provider payments;

  (5) The total amount of monetary recovery as the result of completed investigations;

  (6) The total number of arrests, indictments, and convictions as the result of completed investigations.

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An annual financial audit of the MO HealthNet fraud unit within the attorney general's office shall be conducted and completed by the state auditor in order to quantitatively determine the amount of money invested in the unit and the amount of money actually recovered by such office.

  2. By January 1, 2008, and annually thereafter, the department of social services shall report to the general assembly and the governor the following:

  (1) The number of MO HealthNet provider and participant investigations and audits relating to allegations of violations under sections 191.900 to 191.910 completed within the reporting year, including the age and type of cases;

  (2) The number of MO HealthNet long-term care facility reviews;

  (3) The number of MO HealthNet provider and participant utilization reviews;

  (4) The number of referrals sent by the department to the attorney general's office;

  (5) The total amount of overpayments identified as the result of completed investigations, reviews, or audits;

  (6) The amount of fines and restitutions ordered to be reimbursed, with a delineation between amounts the provider has been ordered to repay, including whether or not such repayment will be completed in a lump sum payment or installment payments, and any adjustments or deductions ordered to future provider payments;

  (7) The total amount of monetary recovery as the result of completed investigation, reviews, or audits;

  (8) The number of administrative sanctions against MO HealthNet providers, including the number of providers excluded from the program.

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An annual financial audit of the program integrity unit within the department of social services shall be conducted and completed by the state auditor in order to quantitatively determine the amount of money invested in the unit and the amount of money actually recovered by such office.

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(L. 2007 S.B. 577)