As used in this part 8, unless the context otherwise requires: “Abuse” means willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical or financial harm or pain or mental anguish, including any acts or omissions that constitute a criminal violation under state law. “Beneficiary” means any individual who receives goods or services […]
There is created within the department of law and under the control of the office of the attorney general the medicaid fraud control unit. The unit shall investigate and prosecute fraud, misuse, waste, and abuse committed by medicaid providers and investigate and prosecute cases of patient abuse, neglect, and exploitation. Source: L. 2018: Entire part […]
The department of health care policy and financing; the department of public health and environment; managed care entities; and their fiscal agents, contractors, or subcontractors, shall refer all cases where the agency or entity has reasonable cause to believe that there is suspected medicaid fraud and waste as well as patient abuse, neglect, and exploitation […]
The department of health care policy and financing may require that a notification be included in any explanation of benefits provided to a beneficiary that explains the process and contact information for reporting to the unit suspected medicaid fraud and waste as well as patient abuse, neglect, and exploitation. Any notification required pursuant to this […]
In carrying out the responsibilities of this section, the unit has the authority to: Investigate and prosecute civil actions and proceedings, pursuant to section 25.5-4-301 (2) or sections 25.5-4-303.5 to 25.5-4-310; Investigate and prosecute criminal medicaid fraud and waste pursuant to this part 8 and title 18; Investigate and prosecute patient abuse, neglect, or exploitation […]
Civil investigative demands issued pursuant to this part 8 are subject to the requirements of section 25.5-4-309. Subpoenas issued pursuant to this part 8 must comply with the provisions of article 90 of title 13 and any court rule. Any testimony obtained pursuant to a civil investigative demand issued pursuant to this section is not […]
Each application to participate as a provider in the medicaid program, including amendments, updates, renewals, or revalidations thereof; each report stating income or expense upon which rates of payment are or may be based; and each invoice for payment for a good or service provided to a beneficiary must contain a statement that all matters […]
A person commits medicaid fraud and waste when that person knowingly and willfully: With intent to defraud, makes a claim, or causes a claim to be made, knowing the claim contains material information that is false, in whole or in part, by commission or omission; With intent to defraud, makes a statement or representation, or […]
Except as provided in subsection (2) of this section, it is unlawful for any person to knowingly offer, pay, solicit, or receive any remuneration including, but not limited to, any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind: In return for the referral of an individual to a […]
The provisions of this part 8 are not intended to be exclusive remedies and do not preclude the use of any other criminal prosecution directly related to criminal medicaid fraud and waste, as well as criminal patient abuse, neglect, and exploitation, or any other civil remedy for any act that is in violation of this […]
An action brought under this part 8 must be commenced within three years after the date of discovery of the commission of the offense, but no later than six years after the date of the commission of the offense. When a violation of this section is based on a series of acts performed at different […]
