Section 40-8.2-1. – Short title.
§ 40-8.2-1. Short title. This chapter shall be known as the “Rhode Island Medical Assistance Fraud Law.” History of Section.P.L. 1982, ch. 424, § 1.
Section 40-8.2-10. – Other civil remedies and criminal penalties.
§ 40-8.2-10. Other civil remedies and criminal penalties. The penalties and remedies under this statute are not exclusive and shall not preclude the use of any other civil remedy or the application of any other criminal penalty deemed appropriate by the attorney general in accordance with federal law or regulations governing Title XIX or Title […]
Section 40-8.2-11. – Barring or suspending participation in program.
§ 40-8.2-11. Barring or suspending participation in program. Whenever a provider is sentenced or placed on probation for an offense under this chapter, the trial judge may, in his or her discretion, order that the provider be permanently barred from further participation in the program; that the provider’s participation in the program be suspended for […]
Section 40-8.2-12. – Injunctive relief and civil penalties.
§ 40-8.2-12. Injunctive relief and civil penalties. (a) The superior court of this state shall have jurisdiction to prevent and restrain violations of this chapter. In addition to granting prohibitory injunctive and other restraints for a period of time and upon terms and conditions necessary to deter a provider from, and ensure against, the committing […]
Section 40-8.2-13. – Consent decrees.
§ 40-8.2-13. Consent decrees. The attorney general may petition the court to enter a consent decree dismissing any criminal prosecution hereunder, but the court shall review the proceeding to determine whether entry thereof is in the public interest. History of Section.P.L. 1982, ch. 424, § 1.
Section 40-8.2-14. – Investigative demand.
§ 40-8.2-14. Investigative demand. (a) Demand. (1) The attorney general, or his or her designated assistant attorney general, shall have the power to issue a subpoena or subpoena duces tecum. (2) Whenever the attorney general has reasonable cause to believe that any person may have knowledge or be in possession, custody, or control of any […]
Section 40-8.2-15. – Consistency with Confidentiality of Health Care Information Act.
§ 40-8.2-15. Consistency with Confidentiality of Health Care Information Act. No investigative demand pursuant to this chapter shall solicit, extend to, or compel the production, inspection, copying, or release of any record or information otherwise protected as confidential healthcare information pursuant to chapter 37.3 of title 5. History of Section.P.L. 1982, ch. 424, § 1.
Section 40-8.2-16. – Rendering services to recipients after suspension or revocation of certification.
§ 40-8.2-16. Rendering services to recipients after suspension or revocation of certification. No provider shall charge the Rhode Island Medicaid program for any services rendered to recipients subsequent to the revocation or suspension of the provider’s certification except as specified by a termination notice. History of Section.P.L. 1982, ch. 424, § 1.
Section 40-8.2-17. – Stays and review of revocation orders.
§ 40-8.2-17. Stays and review of revocation orders. An order of the executive office of health and human services revoking a provider’s certification may, in the discretion of the program, go into immediate effect or may be stayed. Review of any order may be had in accordance with the Rhode Island administrative procedures act, §§ […]
Section 40-8.2-18. – Filing and enforcement of administrative decision.
§ 40-8.2-18. Filing and enforcement of administrative decision. An administrative decision, not appealed, or which has been affirmed after judicial review under the Rhode Island administrative procedures act, §§ 42-35-1 — 42-35-18, determining any amounts due to the executive office of health and human services or to a provider, may be filed with the clerk […]
Section 40-8.2-19. – Certification as a provider — Revocation or suspension of certification.
§ 40-8.2-19. Certification as a provider — Revocation or suspension of certification. Before any provider of medical services receives payment from the Rhode Island Medicaid program, and as a condition of receipt of payment, the provider must have in effect a valid certification of eligibility from the Rhode Island executive office of health and human […]
Section 40-8.2-2. – Definitions.
§ 40-8.2-2. Definitions. Whenever used in this chapter: (1) “Benefit” means pecuniary benefit as defined herein. (2) “Claim” means any request for payment, electronic or otherwise, and shall also include any data commonly known as encounter data, that is used, or is to be used, for the development of a capitation fee payable to a […]
Section 40-8.2-20. – Eligibility for certification.
§ 40-8.2-20. Eligibility for certification. A certification will apply to any provider who agrees to provide services in accordance with the laws and regulations governing the Rhode Island Medicaid program and who has in effect a proper professional license when a license is a prerequisite to rendering services. Nothing contained herein shall be construed to […]
Section 40-8.2-21. – Suspension of payments to a provider.
§ 40-8.2-21. Suspension of payments to a provider. (a) The executive office of health and human services may issue a suspension of payments order if: (1) The provider does not meet certification requirements of the Rhode Island Medicaid program; or (2) The Rhode Island Medicaid program has been unable to collect (or make satisfactory arrangements […]
Section 40-8.2-22. – Interest on overcharges.
§ 40-8.2-22. Interest on overcharges. Any provider of services or goods contracting with the executive office of health and human services, pursuant to Title XIX or Title XXI of the Social Security Act, who, without intent to defraud, obtains payments under this chapter in excess of the amount to which the provider is entitled, thereby […]
Section 40-8.2-23. – Use of Medicaid funds for anti-union purposes prohibited.
§ 40-8.2-23. Use of Medicaid funds for anti-union purposes prohibited. Medicaid reimbursement for costs incurred directly related to influencing employees regarding their right to organize, to form a union, or to join a union, shall not be considered to be allowable, whether performed directly by the provider or through contracts with consultants or attorneys. History […]
Section 40-8.2-3. – Prohibited acts.
§ 40-8.2-3. Prohibited acts. (a) It shall be unlawful for any person intentionally to: (1) Present, or cause to be presented, for preauthorization or payment to the Rhode Island Medicaid program: (i) Any materially false or fraudulent claim or cost report for the furnishing of services or merchandise; or (ii) Present, or cause to be […]
Section 40-8.2-4. – Statute of limitations.
§ 40-8.2-4. Statute of limitations. The statute of limitations for any violation of the provisions of this chapter shall be ten (10) years. History of Section.P.L. 1989, ch. 501, § 3.
Section 40-8.2-5. – Civil remedy.
§ 40-8.2-5. Civil remedy. Any person, including the secretary of the executive office of health and human services or the office of program integrity acting on behalf of the secretary of the office, injured by any violation of the provisions of § 40-8.2-3 or § 40-8.2-4 may recover through a civil action from the persons […]
Section 40-8.2-6. – Civil actions brought by attorney general on behalf of persons injured by violations of chapter.
§ 40-8.2-6. Civil actions brought by attorney general on behalf of persons injured by violations of chapter. (a) The attorney general may bring a civil action in superior court in the name of the state, as parens patriae on behalf of persons residing in this state, to secure monetary relief as provided in this section […]