Section 42-4-409 – Aggregation of Claims in Certain Cases.
42-4-409. Aggregation of claims in certain cases. The amount of claims relating to violations of this act through a common scheme, or based on the same transaction or occurrence, may be aggregated to determine the level of penalty under this act, whether or not the claims were made as part of the same claim under […]
Section 42-4-410 – Suspension or Exclusion as Provider.
42-4-410. Suspension or exclusion as provider. (a) The department of health or the department of family services may suspend or exclude a provider from providing services and supplies under Medicaid if: (i) The department determines that the provider has committed an offense under this act or the Wyoming Medicaid False Claims Act, whether or not […]
Section 42-4-411 – Provisions of Act Not Exclusive Remedies.
42-4-411. Provisions of act not exclusive remedies. The provisions of this act shall not be exclusive and do not preclude the use of any other criminal or civil remedy as authorized by law.
Section 42-4-412 – Rules.
42-4-412. Rules. The attorney general, in consultation with the department of health, may adopt rules to implement W.S. 42-4-401 through 42-4-409 and 42-4-411.
Section 42-4-403 – Medicaid Fraud Control Unit Created; Duties.
42-4-403. Medicaid fraud control unit created; duties. (a) The Medicaid fraud control unit is recognized and continued in existence within the office of the attorney general. The unit shall conduct a statewide program for investigating and prosecuting violations of all applicable state laws pertaining to fraud in the administration of the Medicaid program and the […]
Section 42-4-404 – Access to Records.
42-4-404. Access to records. (a) Notwithstanding any other provision of law, the unit shall have full access to all records held by a provider or by another person or entity acting on the provider’s behalf, if the unit determines that such information is material to its duties under this act. A provider, or another person […]
Section 42-4-405 – Reporting to Unit.
42-4-405. Reporting to unit. The department of health, department of family services, health care licensing boards, state agencies and the agents, contractors and subcontractors of these entities shall refer to the unit all cases where reasonable cause likely exists that fraud, waste, abuse, bribery or kickbacks relating to Medicaid has occurred, is occurring or will […]
Section 42-4-406 – Fraud and False Statements; Criminal Penalty.
42-4-406. Fraud and false statements; criminal penalty. (a) In relation to the delivery of or payment for services or supplies under Medicaid, a person shall not knowingly, in whole or in part: (i) Make or cause to be made a false or fraudulent claim; (ii) Deliberately conceal a material fact; (iii) Make or cause to […]
Section 42-4-407 – Kickbacks, Bribes, Undisclosed Payments, Referral Fees and Illegal Copayments; Criminal Penalty; Exception.
42-4-407. Kickbacks, bribes, undisclosed payments, referral fees and illegal copayments; criminal penalty; exception. (a) A person shall not knowingly, in whole or in part: (i) Act on behalf of a provider to purchase or lease a service or supply for which payment may be made, in whole or in part, under Medicaid and then solicit […]
Section 42-4-408 – Failure to Maintain Records; Destruction of Records; Penalty.
42-4-408. Failure to maintain records; destruction of records; penalty. (a) A person, after submitting a claim or receiving a payment for a service or supply under Medicaid, shall not knowingly fail to maintain records required under Medicaid, including records that fully disclose the nature of the services or supplies provided to a recipient. (b) A […]