§346-43.5 Medical assistance fraud; penalties. (a) A person commits the offense of medical assistance fraud if:
(1) The person knowingly makes or causes to be made to the medical assistance program any false statement or representation of a material fact in any application for any benefit or payment for furnishing services or supplies, or for the purpose of obtaining greater compensation than that to which the person is legally entitled, or for the purpose of obtaining authorization for furnishing services or supplies; or
(2) The person knowingly makes or causes to be made any false statement or representation of a material fact in any application for any medical assistance benefit or renewal of any medical assistance benefit, or in any statement, document, or record, in written, printed, or electronic form, in support of, or connected with, that application for or renewal of medical assistance benefits.
(b) A person convicted under subsection (a)(2) shall pay restitution equivalent to the amount of medical assistance benefits paid by the State on behalf of that person.
(c) For purposes of this section, the term "medical assistance benefit" means health care coverage or services, including medical, behavioral health, dental, or long-term care services, provided to or paid for on behalf of a person by the State, regardless of source of funding. Payment for medical assistance benefits may be made through capitated payments, insurance premiums, copayments, any payments made by the State to that person's health care providers, and any other payments made by the State on behalf of the person for health care coverage or services.
(d) The offense of medical assistance fraud is a class C felony.
(e) The remedies provided under this section are not exclusive and shall not preclude the use of any other criminal or civil remedy. [L 1980, c 210, §1; am L 2016, c 94, §1]
Cross References
Medicaid fraud unit, see §28-91.
Case Notes
State has compelling interest in ensuring that medicaid program is not being defrauded. 481 F. Supp. 1028 (1979).
Fatal variance between evidence proved and elements of the offense charged in the indictment. 68 H. 343, 713 P.2d 432 (1986).