{"data":{"id":"us-ky/krs-205.6318","jurisdiction":"us-ky","citation":"KRS 205.6318","heading":"Cabinet to establish integrated system to enhance program integrity of","body":"Medical Assistance Program.\nThe Cabinet for Health and Family Services shall review the available technology\nassociated with the medical assistance system to determine which techn ology is best\nsuited to enhance program service operation, monitoring ability, and fraud and abuse\ndetection. This shall include the ability to provide on -line access to data files to allow\ncross-analysis of provider and recipient utilization patterns. The  cabinet shall by\npromulgation of administrative regulations, pursuant to KRS Chapter 13A, establish an\nintegrated system to enhance program integrity, using a combination of staff, computer\ntechnology, and contractual services to identify potential fraud,  abuse, and misutilization\nof services. This system shall:\n(1) Utilize statisticians, program specialists, accountants, nurses, and other medical\nspecialists to review the Medical Assistance Program to identify patterns of\nprovider and recipient behavior t hat contributes to unnecessary or abusive use of\nprogram services;\n(2) Utilize computer capability through contractual services or the purchase of\ncomputer software to detect the unbundling of claims and other techniques used by\nproviders to enhance reimbursement;\n(3) Impose utilization controls on the expenditures in respiratory, physical, speech, and\noccupational therapy and durable medical equipment provided to nursing -home\nresidents, through the use of established medical criteria or preauthorization of\nancillary therapies;\n(4) Establish state audit and edit requirements that exceed the federal audit and edit\nrequirements;\n(5) Obtain access to necessary data from the fiscal agent of each medical provider;\n(6) Review the efficiency and effectiveness of th e fraud and abuse detection and\ninvestigation process to determine whether changes shall be made;\n(7) Direct that fraud and abuse detection and investigation components shall be active\nin initiating investigations. The fraud and abuse detection, investigat ion, and\nprosecution functions shall be integrated, with access to information in files\nmaintained by the Department for Community Based Services and the Department\nfor Medicaid Services;\n(8) Review penalties for deterrent value for medical providers that are found to have\nabused Medicaid regulations and statutes; and\n(9) Provide for a proactive effort to reduce costs for institutionalized program\nparticipants. Program officials shall seek to implement innovative or experimental\ndemonstration programs that aim to control costs.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=7764","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"825e6ece571cf81ee6f180d77a9abebaeb22eca75f3e450e955f6327c1df6c73","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.63171","next":"us-ky/krs-205.632"},"notice":"GroundRules: Original legal text. Not legal advice."}