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Puerto Rico gov signs bill to help prevent Medicaid fraud, secure federal health funds

By on July 23, 2018


SAN JUAN – Gov. Ricardo Rosselló has enacted a measure that establishes the Fraudulent Claims to Programs, Contracts and Services of the Government of Puerto Rico Act and creates a “recovery mechanism” for cases where false claims are identified, his office, La Fortaleza, announced Monday.

House Bill 1627, which derives “from the federal False Claims Act,” La Fortaleza said, states that claims will be handled by the Medicaid Fraud Control Unit at the Puerto Rico Department of Justice.

The creation of the office, along with the establishment of the Medicaid Management Information System (MMIS), “ensures the allocation of $1.2 billion in federal funds for the Island (BBA Disaster Relief Funds),” according to the release.

“With this law, we join 49 states and Washington, DC as jurisdictions that have dedicated units to address fraud in the Medicaid health program. The timely detection of this behavior will be helpful for its beneficiaries as it ensures the availability and continuity of these funds,” the governor said.

La Fortaleza added that “the governor had channeled the public policy of addressing the problem of Medicaid fraud” via Executive Order 2017-12.

“With this measure, we achieve the necessary requirements to be recipients of additional federal funds, by committing ourselves to supervise and prosecute those people who misuse Medicaid. This policy of zero tolerance against fraud is linked to the My Health Reform that will put the patients first, giving them the right to choose their health providers,” the release quoted the governor as saying.

“In February, together with Resident Commissioner Jenniffer González, we achieved in Congress a historic appropriation of $4.9 billion for the over 600,000 beneficiaries of the Medicaid program. This allocation allows the Mi Salud [public healthcare] program to be fully funded for the next two years without requiring state funds that have been affected by the fiscal crisis and the emergency caused by the hurricanes last year,” Rosselló said.

The governor added that “from this amount in federal funds for health, $1.2 billion are conditioned to taking affirmative steps, such as this measure that we sign into law today.”

The Rosselló administration recalled it announcedthe establishment of the first MMIS on the island in April, which “had been required without success by the federal Government since 2009….”

The new law urges whistleblowers to report fraud, providing them with “the amount recovered by the Government.” The release adds that under “this system, the federal Government has recovered $31.9 million from 2009 to 2016.”

“The Department of Justice has already begun by creating the Medicaid Fraud Control Unit by administrative order,” Secretary Wanda Vázquez added in the release, saying that “dealing with the loss of public funds assigned to our Island is of paramount importance to ensure the trust of the Government of the United States in our Government agencies. A strong message is also sent to those who defraud and profit at the expense of the need of other people.”

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