Feb. 28, 2023
HARRISBURG – Republican Appropriations Chairman Seth Grove (R-York) was joined by Reps. Clint Owlett (R-Tioga/Bradford), Valerie Gaydos (R-Allegheny), Mike Cabell (R-Luzerne) and Stephenie Scialabba (R-Butler) to introduce a package of bills aimed at reducing fraud within state government, specifically when it comes to Medicaid.
“As Republican chairman of the Appropriations Committee, I have held roundtable discussions covering a variety of fiscal issues,” said Grove. “These roundtables have underscored the importance of stretching every dollar. A variety of factors – including demographic shifts – have put Pennsylvania on a path toward fiscal insolvency. In 2020, with the help of then-Attorney General Josh Shapiro, we introduced these measures. Unfortunately, these bills did not pass last session, but we hope Gov. Shapiro views them as a priority for his administration this year.”
To this end, Grove will reintroduce a bill to adopt a state version of the Federal False Claims Act, which would allow the Commonwealth to, during national settlements, recoup an additional 10% from false claims made against Medicaid. Additionally, this legislation empowers the attorney general’s office, or a district attorney designated by the attorney general, to investigate other potential cases of false claims made against the Commonwealth.
Owlett will reintroduce a Do Not Pay bill that mirrors the federal program. “The Do Not Pay system is designed to prevent improper payments by streamlining the process for referencing a variety of data sources to determine who may be ineligible to receive taxpayer funds,” Owlett said. “Stopping improper payments before they happen has the potential to save the Commonwealth millions of dollars, not only by avoiding payments to ineligible people but also by avoiding the costs associated with trying to recover funds that were improperly paid out.”
In order to prevent improper payments within state programs, legislation by Gaydos, which mirrors the Federal Improper Payment law, would require agencies to review their programs and expenditures and assess whether they are highly, moderately or unlikely to be susceptible to an improper payment.
“With Medicaid, like everything else, we expect our state agencies to operate competently and in the best interest of the taxpayer,” Gaydos said. “My legislation will ensure those agencies are safeguarded against interruptions to patient service that result from improper payments.”
Another bill in this package will be introduced by Cabell to create the National Provider Identification Number. “Medicaid providers should be held to a high standard of accountability,” Cabell said. “Tracking who provided what services should be easy. By simply requiring a national or state provider identification number, we can achieve this.”
The final bill discussed at the press conference is by Scialabba, which involved provider preventable conditions. The bill specifically permits fines to be levied should a medical procedure be botched which should have been easily avoided.
“Federal law bars reimbursement for provider preventable conditions,” said Scialabba “There is no reason why taxpayers should be paying for mistakes made by providers such as surgery performed on the wrong body part or a condition created by poor medical practices. My bill will place penalties on Medicaid providers who make such egregious errors and pass the bill onto taxpayers.”
“Just a few years ago, Josh Shapiro stood with us on this package of bills, claiming then we could be losing $3 billion per year to fraud
. Today, we’re calling on him to work with us once again to see this legislation signed into law,” Grove concluded.
Representative Seth Grove
Pennsylvania House of Representatives
Media Contact: Charlie O’Neill