July 21, 2019

SB 13-137: Implementing a Medicaid Fraud Detection System

On Tuesday, January 29, 2013, Sen. Ellen Roberts introduced SB 13-137 – Concerning System Improvements to Prevent Fraud in the Medicaid Program, and, in Connection Therewith, Employing Advanced Data Analytics. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill directs the chief information officer of the office of information technology (office) to design and implement a Medicaid fraud detection system (system) for the purpose of detecting and preventing Medicaid provider and client fraud, waste, and abuse.

The system designed by the chief information officer shall include industry best practices relating to fraud detection and prevention. The chief information officer shall also incorporate emerging strategies and technologies into the system as they become available.

Among other data and information, the system shall utilize Medicaid claims and billing data and information from providers, and state and federal agency data-matching systems.

Utilizing appropriate data-sharing protocols, the bill requires state agencies to provide data and information to the office for purposes of implementing the system.

The bill requires the department of health care policy and financing (state department) to collaborate with the office in the design, implementation, and operation of the system. Consistent with state and federal law concerning data sharing and medicaid records, the state department shall provide necessary data and information to the office concerning medicaid providers and clients.

The state department shall participate in securing funding for the system, as such funding may be available, and shall consider various funding mechanisms for the system. The bill is assigned to the Health & Human Services Committee.