Alabama: Examples of fraud include the following:

Transcription

1 Alabama: Alabama law does not provide for civil false claim actions, as does the federal False Claims Act, but prosecutors may bring criminal actions against any person who knowingly makes or causes to be made or assists in the preparation of any false statement, representation or omission of a material fact in any claim or application for payment from the Medicaid Agency with the intent to defraud or deceive. Criminal penalties can include fines of up to $10,000 and imprisonment. Pursuant to the Alabama Medicaid regulations, when there has been fraud or abuse against the Medicaid program, in addition to the criminal penalties discussed above, administrative sanctions may also be imposed. These sanctions include, among other things, suspension of Medicaid payments, suspension of Medicaid participation, and termination of Medicaid participation. The Medicaid program defines fraud for these purposes as an intentional deception or intentional misrepresentation made by a person with the knowledge that the deception could result in some unauthorized personal benefit or unauthorized benefit to some other person. Examples of fraud include the following: - charging recipients for services over and above that paid for by Medicaid; - double billing or other illegal billing practices; - submitting false medical diplomas or licenses in order to qualify as a - Medicaid provider; - ordering tests, prescriptions or procedures the patient does not need; - rebating or accepting a fee or a portion of a fee for a Medicaid patient - referral; - failing to repay or make arrangements for the repayment of identified - overpayments; and - physical, mental, emotional or sexual abuse of a patient. Whistleblower protection under Alabama law is limited to public employees. See Ala. Code ; Ala. Admin. Code r. 560-X

2 Arizona: The Arizona False Claims Statute was enacted to prevent a person from using fraud to obtain health care benefits. Under the statute, knowingly submitting false claims for obtaining medical assistance may be a crime. Violations include: - presenting a claim for a medical item or service that the person knows or has reason to know was not provided as claimed; - presenting a claim for a medical item or service that the person knows or has reason to know is false or fraudulent; or - making a request for payment that the person knows or has reason to know is a violation of an agreement between the person and the State. A person who violates the statute will be civilly liable for a penalty of up to $2,000 per violation and an assessment of up to twice the amount that is wrongfully claimed. The person may also be prosecuted criminally and may be convicted of a Class 5 felony. Arizona law also provides whisteblower protection for individuals who report suspected fraud. Specifically, providers of Medicaid services have a duty to report suspected fraud and will be immune from civil liability for such reporting. They will also be protected from any retaliation their employer may take. See Ariz. Stat. Ann , , and

3 Arkansas: The Arkansas Medicaid Fraud False Claims Act creates civil and criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to prevent a person from using fraud to obtain benefits or payments from the state. Under the statute, knowingly making false claims to the Arkansas Medicaid program may be a crime. Violations include, but are not limited to: - knowingly making or causing to be made any false statement or representation of a material fact in any application for any benefit or payment under the Arkansas Medicaid program or for determining rights to a benefit or payment; - knowingly presenting or causing to be presented a claim for a physician s service for which payment may be made under the program with knowledge that the individual who furnished the service was not licensed as a physician; or - knowingly offering or paying any remuneration or soliciting or receiving any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind in return for referring an individual to a person for the furnishing of any item or service or for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under the Medicaid program. A person who violates the Arkansas Medicaid Fraud False Claims Act may be liable to the state for up to $10,000 per violation, plus three times the amount of damages that the state suffered as a result of the false claims. Violators may also face criminal prosecution. Arkansas law rewards individuals who report or file claims reporting suspected fraud. Individuals who file a lawsuit may also receive up to $100, or up to ten percent of any recovery, as the court may deem just. See Ark. Code Ann through ; Ark. Crim. Code

4 California: The California False Claims Act ( CFCA ), California Government Code Sections , prohibits conduct similar to that addressed under the federal False Claims Act. Specifically, the law prohibits any person from submitting a false or fraudulent claim of over $500 to the state or local government. The CFCA also makes it illegal for any person who benefits from a false claim, and later discovers the falsity of the claim, to fail to disclose the false claim to the applicable state or local government. The CFCA does not apply to workers compensation claims, tax claims, or claims against public entities and employees. California officials may file a lawsuit against a suspected violator of the CFCA, or alternatively, a private individual, such as an employee, may file a qui tam lawsuit on behalf of the government. California officials may choose to participate in the qui tam lawsuit or allow the individual to proceed alone on the state or local government s behalf. If the case is successful, the individual is entitled to a portion of the government s monetary recovery. Employees who assist or participate in an action under the CFCA are protected from workplace retaliation. The CFCA imposes a civil penalty of up to $10,000 for each separate violation of the law. Violators may also need to pay the applicable state or local government an amount equal to two to three times the value of the false claim. California Welfare & Institutions Code Section prohibits fraud involving funds of the state s medical assistance programs, including Medi-Cal. This statute establishes grounds for both criminal and civil actions against any person who knowingly defrauds Medi-Cal or other state medical assistance programs by submitting false claims or making false representations. These actions, however, may only be brought by state officials; private individuals cannot file qui tam lawsuits under this provision. Penalties for a violation of this statute include imprisonment and/or a fine not exceeding three times the amount or value of the fraud. California Insurance Code Section prohibits a person from knowingly presenting a false claim for a health care benefit to a private insurer. Actions under this statute may be brought by the district attorney or the California Insurance Commissioner or alternatively, a qui tam lawsuit may be filed on behalf of the state by a private individual, such as an employee. The state or district officials may choose to participate in the qui tam lawsuit or allow the individual to proceed alone on the state s behalf. If the case is successful, the individual is entitled to a portion of the state s monetary recovery. Employees who assist or participate in an action under this statute are protected from workplace retaliation. Penalties for a violation of this statute include a civil penalty of between $5,000 to $10,000, plus an assessment not exceeding three times the amount of each fraudulent claim. In addition, there may be a separate criminal prosecution for violations of this statute. See Cal. Gov t. Code et seq.

5 Colorado: Colorado s False Claims Act creates civil and criminal penalties for false claims and statements. The Act is intended to prevent a person from using fraud to obtain benefits or payments from the state s medical assistance program. Under the statute, knowingly submitting false claims to an employee or agent of the state may be a crime. Violations include: - intentionally or with reckless disregard making or causing to be made any false representation of a material fact in connection with a claim; intentionally or with reckless disregard presenting or causing to be presented to the state department a false claim for payment or approval; - intentionally or with reckless disregard presenting or causing to be presented any cost document required by the medical assistance program that the person knows contains a false material statement; or intentionally or with reckless disregard offering, soliciting, receiving, or - paying any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind in exchange for referring an individual or for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, ordering, or arranging for any good, facility, service, or item under the state s medical assistance program. Examples of lawful payments are payments that are properly made and reported in claims submitted for payment; payments made by an employer to an employee when the two share a legitimate employment relationship; payments made by a seller to a person who is authorized to act as a buyer; or payments made based on a written contract. A person who violates the Colorado False Claims Act may be liable to the state for up to $5,000 per false claim or two times the amount of the assistance received by false claims, and full repayment of the amount suffered by the state as a result of the false claims. See Col. Rev. Stat &

6 Connecticut: The Connecticut Health Insurance Fraud Act creates civil and criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to prevent a person from using fraud to obtain health care benefits. Under the statute, knowingly submitting false claims to an employee or agent of an insurer may be a crime. Violations include: - knowingly making false statements in applying for health care benefits; - conspiring to defraud an insurer to obtain health care benefits; or - falsely making claims for medically unnecessary goods or services. A person who violates the statute is liable to the insurer for the overpayments made because of false claims, the insurer s litigation fees, and criminal penalties including probation. Under the Connecticut law, protections exist for individuals who report suspected health insurance fraud. An individual will be protected from a lawsuit if he or she files a report of the suspected fraud to the Insurance Commissioner. He or she may reveal personal or private information of another individual that is important to investigating the violation. See Conn. Gen. Stat through

7 Delaware: The Delaware False Claims and Reporting Act creates civil and criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to prevent a person from using fraud to obtain health care benefits. Under the statute, knowingly making false claims to an employee or agent of the state may be a crime. Violations include: - knowingly making false statements to get a claim approved; conspiring to defraud the state by getting a false claim paid; - delivering less property to the government than the amount that the person receives a receipt for; - delivering a receipt to the government without knowing that the information on the receipt is true; - knowingly receiving public property from an officer or employee of the state from someone who the person knows may not lawfully sell the property; and - knowingly concealing a record to falsify an obligation to pay, or receive payment from, the state government. A person who violates the Delaware False Claims and Reporting Act may be liable to the state for up to $11,000 plus three times the amount the state suffered as a result of the false claims, as well as the amount it costs the government to bring the action against the individual. Under Delaware law, protections exist for individuals who report or file claims related to suspected false claims. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status, two times the amount of back pay, and compensation for litigation costs and damages. Individuals who file a lawsuit under the Delaware False Claims and Reporting Act may also receive a percentage of any recovery. This percentage varies depending on whether the government chooses to intervene. See Del. Code Ann

8 District of Columbia: The District of Columbia False Claims Act creates civil and criminal penalties for false claims and statements and allows certain whistleblower protections. The Act is intended to prevent a person from using fraud to obtain benefits or payments from the District of Columbia. Under the statute, knowingly presenting, or causing to be presented, to an officer or employee of the District a false claim for payment or approval may be a crime. Violations include: - knowingly presenting, or causing to be presented, to an officer or employee of the District a false claim for payment or approval; - knowingly making, using, or causing to be made or used, a false record or statement to get a false claim paid for or approved by the District; - conspiring to defraud the District by getting a false claim allowed or paid by the District; - benefitting from an inadvertent submission of a false claim to the District, and subsequently discovering the falsity of the claim, but failing to disclose the false claim to the District; and - benefitting from an inadvertent payment or overpayment by the District of monies not due and knowingly failing to repay the inadvertent payment or overpayment to the District. A person who violates the Act will be liable to the state for up to three times the amount of damages sustained by the state and up to a $10,000 penalty for each violation. A violator may also be prosecuted criminally. D.C. law also protects individuals who report or file claims that report suspected fraud under the District s False Claims Act. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status; the amount of back pay, with interest; and compensation for special damages, including litigation costs and reasonable attorney fees. Individuals who file a lawsuit may also receive a percentage of any recovery. The percentage received varies depending on whether the government chooses to intervene. See D.C. Code et seq.

9 Florida: The Florida False Claims Act creates civil or criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to prevent a person from using fraud to obtain benefits or payments (e.g., Medicare claims) from the state government. Under the statute, knowingly making false claims to the Florida Agency for Health Care Administration may be a crime. Violations include: - knowingly making false statements to get a false claim paid for or approved; - conspiring to defraud the state in order to obtain payments; - delivering less public property or money than the amount that the person receives a receipt for; - falsifying a receipt regarding the delivery of property; - knowingly receiving public property from any person who may not lawfully disburse the property; and - knowingly concealing an obligation to pay money or property to the state. A person who violates the Florida False Claims Act may be liable to the state for three times the amount of damages that the state suffered as a result of the false claims, the litigation costs to recover those damages, and up to $11,000 for each false claim made. Under Florida law, protections exist for individuals who report or file claims related to suspected fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status, recovery of back pay, and compensation for litigation costs and damages. Individuals who file a lawsuit under the Florida False Claims Act may also receive a percentage of any recovery. This percentage varies depending on whether the government chooses to intervene. See Fla. Stat et seq.

10 Georgia: The Georgia false claims law prohibits conduct similar to that addressed under the federal False Claims Act, but the Georgia provisions apply specifically to the submission of false or fraudulent claims for payment by the state s Medicaid program. The law allows state officials to seek criminal penalties for violations. A provider can also be liable for a civil penalty of three times the amount of any excess payment made by the state s Medicaid programs and significant monetary damages per false claim. However, if the person committing the violation meets certain requirements by reporting the violation and cooperating with any subsequent government investigation, damages will be limited to two times the amount of actual damages suffered by the state Medicaid program. A civil false claims action may be brought by the state Attorney General or by a private person in the name of the State of Georgia to which the Attorney General may elect to intervene. The Georgia false claims law also includes whistleblower protection against workplace retaliation for civil actions brought by or assisted by an employee under the law. See Ga. Code Ann et seq.; Ga. Code Ann

11 Idaho: The Idaho False Claims Act creates civil penalties for false claims and statements. The Act is intended to prevent a person from using fraud to obtain benefits or payments (e.g., Medicare claims) from the state government. Under the statute, knowingly making false claims to the Idaho Department of Health and Welfare may be a crime. Violations include: - Knowingly making false statements to get a false claim paid for or approved - Submitting a false claim - Knowingly making a false statement or representation of material fact in any document required to be maintained or submitted to the state - Conspiring to defraud the state in order to obtain payments - Submitting a claim for an item or service known to be medically unnecessary - Failure to provide, upon written request by the state, immediate access to documentation - required to be maintained - Repeated or substantial failure to comply with the rules and regulations governing medical assistance payments or other public assistance program payments - Knowing violation of any material term or condition of a provider agreement - Failure by a managing employee to repay any overpayments or claims previously found to have been obtained contrary to statute, rule, regulation or provider agreement; - Engaging, or was a managing employee in any entity which has been found to be engaging, in fraudulent conduct or abusive conduct in connection with the delivery of health care or public assistance items or services. A person who violates the Idaho False Claims Act may be excluded from participation in state public assistance programs, including Medicaid. Such person may also be liable for civil penalties of up to $1,000 for each claim. See Idaho Code Ann (h).

12 Illinois: The Illinois Whistleblower Reward and Protection Act creates civil and criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Chicago False Claims Act also offers whistleblower protections. Under the Illinois Whistleblower Reward and Protection Act, knowingly making false claims to an employee or agent of the state may be a crime. Violations include: - knowingly making false statements in applying for Medicaid benefits; - conspiring to defraud the state in order to obtain Medicaid benefits; - delivering less public property or money than the amount that the person - receives a receipt for; - falsifying a receipt regarding the delivery of property; - knowingly receiving public property from any person who may not lawfully disburse the property; - knowingly falsifying a record regarding the payment of money or property to the state; - delivering a receipt to the government without knowing that the information on the receipt is true; - knowingly receiving public property from an officer or employee of the state from someone who the person knows may not lawfully sell the property; and - knowingly falsifying a record regarding the payment of money or property to the state. A person who violates the Illinois False Claims Act may be liable to the state for three times the amount of damages that the state suffered as a result of the false claims, the litigation costs to recover those damages, and up to $11,000 for each false claim made. Under Illinois law, protections exist for individuals who report or file claims related to suspected Medicaid fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they made the report. This may include reinstatement with the same seniority status, two times the amount of back pay including interest, and compensation for litigation costs and damages. Individuals who file a lawsuit under the Illinois False Claims Act may also receive a percentage of any recovery. This percentage varies depending on whether the government chooses to intervene. The Chicago False Claims Act also offers whistleblower protection under the Chicago Municipal Code. It was enacted to prevent a person from presenting or causing to be presented a false or fraudulent claim to a city official or employee. Under the Chicago False Claims Act, no person may take retaliatory action against an employee who discloses any violation or provides information of a violation to the city. If any action is taken against an employee because of that disclosure, the employee is entitled to reinstatement, two times the amount of back pay, and reinstatement of full fringe benefits and seniority rights. See Ill740 Ill. Comp. Stat. 175/1 et seq. (Illinois Whistleblower Reward and Protection Act);

13 Chicago Municipal Code , ; , ; and (Chicago False Claims Act).

14 Indiana: Like the federal False Claims Act, the Indiana False Claims and Whistleblower Protection Act ( IFCA ) imposes liability on persons or companies that make or cause to be made false or fraudulent claims to the government for payment or who knowingly make, use or cause to be made or used, a false record or statement to get a false or fraudulent claim paid by the government. The law applies to Medicaid reimbursement and prohibits, among other things: - Billing Indiana s Medicaid program for services not rendered; - Submitting a false claim for payment; - Making or using a false record to get a false claim paid; - Making or using a false record to avoid payments; and - Participating in kickbacks. A violation of this law may result in civil penalties of $5,000 per claim, plus three times the amount of damages sustained by the state government. See Ind. Code Indiana allows civil lawsuits to be filed by the state government or by private citizens, including employees. If the private citizen (also called a qui tam plaintiff) is successful in the lawsuit, he or she may share a percentage of any monetary recovery and receive an award for reasonable attorney s fees and costs. However, if the state chooses not to litigate a case, and the private citizen litigates and loses, then the court may award the defendant its reasonable attorney fees and costs against the private citizen. See id The IFCA also prohibits employers from retaliating, discriminating against or harassing employees because of their lawful participation in a false claims disclosure or their refusal to assist employers in violating laws such as the IFCA. The law provides for certain monetary awards and equitable relief to the prevailing plaintiff, including compensation for lost wages and reinstatement to a former position. See id Another Indiana law makes it a felony to knowingly or intentionally commit Medicaid fraud. Specifically, in Indiana it is a felony to: (1) file a Medicaid claim in violation of Indiana s Medicaid laws; (2) obtain payment from the Medicaid program by means of a false or misleading oral or written statement or other fraudulent means; (3) acquire a provider number under the Medicaid program except as authorized by law; (4) alter or falsify provider documents or records with the intent to defraud; and/or (5) conceal information for the purpose of applying for or receiving unauthorized payments from the Medicaid program. See id Finally, Indiana has a separate whistleblower provision that protects employees of private employers that are under public contract. An employee must first report an alleged violation of state or federal law or misuse of public resources concerning the execution of a public contract to the private employer (unless that person is the one committing the violation). If a good faith effort is not made to correct the problem within a reasonable time, the employee may then submit a written report of the incident to any person, agency, or organization. See id See Ind. Code et seq.

15 Kansas: The Kansas False Claims Act creates civil and criminal penalties for false claims and statements and affords whistleblower protections for certain activities. Under the statute, a person who commits any of the following acts shall be liable to the state or any affected political subdivision thereof, for three times the amount of damages which the state or such political subdivision sustains because of the act of that person and shall be liable to the state for a civil penalty of not less than $1,000 and not more than $11,000 for each violation. The following acts constitute violations for which civil penalties, costs and attorney fees may be recovered by a civil action under this act: - knowingly presents or causes to be presented to any employee, officer or agent of the state or political subdivision thereof or to any contractor, grantee or other recipient of state funds or funds of any political subdivision thereof, a false or fraudulent claim for payment or approval; - knowingly makes, uses or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved; - defrauds the state or any political subdivision thereof by getting a false claim allowed or paid or by knowingly making, using or causing to be made or used, a false record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state or to any political subdivision thereof; - has possession, custody or control of public property or money used or to be used by the state or any political subdivision thereof and knowingly delivers or causes to be delivered less property or money than the amount for which the person receives a certificate or receipt; - is authorized to make or deliver a document certifying receipt of property used or to be used by the state or any political subdivision thereof and knowingly makes or delivers a receipt that falsely represents the property received; - knowingly buys or receives as a pledge of an obligation or debt, public property from any person who lawfully may not sell or pledge the property; - is a beneficiary of an inadvertent submission of a false claim to any employee, officer or agent of the state or political subdivision thereof, or to any contractor, grantee or other recipient of state funds or funds of any political subdivision thereof, who subsequently discovers the falsity of the claim and fails to disclose the false claim and make satisfactory arrangements for repayment to the state or affected political subdivision thereof within a reasonable time after discovery of the false claim; - conspires to commit any violation set forth above. Any employee who is discharged, demoted, suspended, threatened, harassed or in any other manner retaliated against in the terms and conditions of employment by such employee s employer because of lawful acts undertaken in good faith by the employee on behalf of the employee or others, in furtherance of an action under this act, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this act, shall be entitled to all relief necessary to make the employee whole.

16 An employee may bring an action in the appropriate district court for the relief provided in this section. The Kansas Medicaid Fraud Control Act was enacted to prevent a person from using fraud to obtain benefits or payments from the State s medical assistance program. Under the statute, knowingly making false claims to an employee or agent of the State may be a crime. Violations include: - knowingly making false statements in applying for Medicaid benefits; - knowingly making false claims for medically unnecessary goods or services; - knowingly making a false report for computing the payment for any goods or services; - knowingly receiving or paying any compensation, such as any kickbacks or rebates, in exchange for referrals or purchases; - knowingly trading a Medicaid number for money or other compensation; and - destroying, concealing or failing to maintain adequate records necessary for computing Medicaid payments. A person who violates the Kansas statute may be subject to criminal penalties, the amount in damages suffered by the State, and the State s litigation costs. The Attorney General may prosecute suspected violators. See Kan. Stat. Ann et seq.; Kan. SB 44.

17 Kentucky: Kentucky has both civil and criminal penalties for submission of false claims to the medical assistance program. Specifically, the Kentucky Medicaid Fraud Statute prohibits the submission of any fictitious, false or fraudulent application, claim, report or document to obtain payments from any medical assistance program, or in connection with determining rights to any benefit or payment. The law also prohibits the making of a false statement or false representation of a material fact in connection with the certification of a provider for participation in Medicaid. A knowing state of mind is required for each type of prohibited conduct. In addition, providers who are found to have knowingly submitted, or caused to be submitted claims for payment to which they were not entitled are liable for restitution of the excess payment, payment of up to three times the amount of damages sustained by the Medicaid program, a civil penalty of $500 for each false claim submitted, and for fees and costs in connection with the investigation and enforcement of the law. This law does not have a qui tam provision permitting a private person to bring an action; rather, the law is enforced by the Attorney General. However, any person who knows or has reasonable cause to believe that a violation of the law has occurred is required to report the violation to the Medicaid Fraud Control Unit. The identity of any person reporting Medicaid fraud is confidential. Any person making a good faith report of the offense may not be liable in any civil or criminal action based upon the report. Further, no employer may discharge, discriminate or retaliate against a person who reports fraud in good faith, or who testifies or is about to testify about the fraud. If an employer fires, discriminates against or retaliates against a person reporting fraud, the reporting person may sue the employer for actual damages, costs and attorneys fees. See Ky. Rev. Stat. Ann et seq.

18 Louisiana: The Louisiana Medical Assistance Programs Integrity Law creates civil or criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to combat and prevent fraud and abuse (e.g., the submission of false claims) among providers participating in the medical assistance programs. Under the statute, knowingly making false claims to the Louisiana Department of Health & Hospitals may be a crime. Violations include: - knowingly making false statements or false records to get a false claim paid for or approved; - conspiring to defraud the commonwealth in order to obtain payments; - knowingly concealing an obligation to pay money or property to the state; and - knowingly submitting a claim for goods, services, or supplies which were medically unnecessary or which were of substandard quality or quantity. A person who violates the Louisiana False Claims Act may be liable to the state for three times the amount of damages that the state suffered as a result of the false claims, the litigation costs to recover those damages, the costs of investigation of the claims, and up to $10,000 for each false claim made. Under Louisiana law, protections exist for individuals who report or file claims related to suspected fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include recovery of back pay and compensation for litigation costs and damages. Individuals who file a lawsuit under the Louisiana False Claims Act may also receive a percentage of any recovery. This percentage varies depending on whether the government chooses to intervene. See La. Rev. Stat. Ann

19 Maine: Maine state law, under the Civil Liability of Persons Making False Claims statute, creates civil penalties for false claims and statements and affords whistleblower protections for certain activities. Under the statute, knowingly making false claims to the Maine Department of Health and Human Services may be a crime. Violations include: - making or causing to be made a false or fraudulent claim for payment or approval to be submitted to the state knowing such claim to be false, fictitious or fraudulent; - making any false written statement; or - submitting any false document in connection with such a claim. A person who violates the statute may be subject to civil suit by the State of Maine and required to pay (i) restitution for excess benefits or payments made, (ii) interest on restitution amounts awarded, (iii) civil penalties of up to three times the amount of the excess benefits or payments, but not less than $2,000 for each false claim or false document submitted in support of such false claim, (iv) the State s litigation costs, (v) the State s investigation costs, and (vi) the State s attorney s fees. Under Maine law, protections exist for individuals who report or file claims related to suspected fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include recovery of back pay and compensation for litigation costs and damages. See Me. Rev. Stat. Ann. tit and tit

20 Maryland: Maryland has enacted a series of laws that work together to deter a person from using fraud to obtain benefits or payments from a state health plan. See Md. Crim. Law Code Ann , ; Md. Health Occupations Code 1-501, ; and Md. Health-General Code Ann , Under the state s false claims statute, knowingly making false claims to obtain payments from a state health plan may be a crime. Violations include: - knowingly defrauding a state health plan; - providing or receiving kickbacks or rebates for the furnishing of goods, services or referrals payable under the state health plan; - using false representations in order to qualify an institution, facility or state health plan for reimbursement under a state health plan; - knowingly obtaining payment under a state health plan by hiding facts, counterfeiting prescriptions or using a false name or address; or - knowingly possessing a medical assistance card or a pharmacy assistance card without the authorization of the person to whom the card is issued. A person who violates the statute may be subject to criminal penalties, such as imprisonment and/or criminal fines. In addition, a person who violates the statute will be civilly liable to the state for up to three times the amount of the benefits received as a result of the false claims. See Md. Crim. Law Code Ann , Under Maryland law, protections exist for individuals who report or file claims for suspected activities intended to defraud the state health plan. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status and benefits; back pay; a removal of adverse personal record entries; and compensation for litigation costs, including reasonable attorneys fees. See Md. Health Occupations Code Ann However, employees will only be guaranteed these protections if they report in good faith. See Md. Health Occupations Code Ann See Md. Crim. Law Code Ann , ; Md. Health Occupations Code 1-501, ; and Md. Health-General Code Ann ,

21 Massachusetts: The Massachusetts False Claims Act creates civil or criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to prevent a person from using fraud to obtain benefits or payments (e.g., Medicare claims) from the state government. Under the statute, knowingly making false claims to the Massachusetts Office of Health and Human Services may be a crime. Violations include: - knowingly making false statements to get a false claim paid for or approved; - conspiring to defraud the commonwealth in order to obtain payments; - delivering less public property or money than the amount that the person receives a - receipt for; - falsifying a receipt regarding the delivery of property; - knowingly receiving public property from any person who may not lawfully disburse the property; - knowingly concealing an obligation to pay money or property to the state; and - benefitting from an inadvertent submission of a false claim to the commonwealth and failing to disclose the false claim to the commonwealth within a reasonable time after discovery of the false claim. A person who violates the Massachusetts False Claims Act may be liable to the state for three times the amount of damages that the state suffered as a result of the false claims, the litigation costs to recover those damages, the costs of investigation of the claims, and up to $10,000 for each false claim made. Under Massachusetts law, protections exist for individuals who report or file claims related to suspected fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include recovery of back pay and compensation for litigation costs and damages. Individuals who file a lawsuit under the Massachusetts False Claims Act may also receive a percentage of any recovery. This percentage varies depending on whether the government chooses to intervene. See Mass. Gen. Laws ch. 12 5A, 5B, and 5F; Mass. Gen. Laws ch

22 Michigan: The Michigan Medicaid False Claims Act, Mich. Comp. Laws Serv , , was enacted to prevent a person from using fraud to obtain benefits or payments from a State medical assistance program. Under the statute, knowingly making false claims to an employee or agent of the State may be a crime. Violations include: - knowingly making false statements in applying for Medicaid benefits; - failing to make known an event that affects a person s right to receive Medicaid benefits; - receiving kickbacks or rebates for furnishing goods or services payable by Medicaid; - conspiring to defraud the State by aiding another in obtaining Medicaid; - using false statements in order to qualify an institution or facility as a hospital, skilled nursing facility, intermediate care facility or home health agency; - concealing an obligation to pay the State for services; or - knowingly making a false claim for unnecessary medical goods or services. A person who violates the statute shall be liable to the State for the full amount of benefits received by that person; triple the amount of damages that the State suffered as a result of the false claims; a civil penalty of up to $10,000 per violation; and the State s litigation and enforcement costs. See Mich. Comp. Laws Serv b, Violations may also result in criminal penalties of up to four years in prison, a fine of up to $50,000, or both. See Mich. Comp. Laws Serv , In addition, under Michigan law, protections exist for individuals who report or file claims related to suspected Medicaid fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status, two times the amount of back pay with interest; and compensation for special damages, such as litigation costs. See Mich. Comp. Laws Serv c. Individuals who file a lawsuit under the Michigan Medicaid False Claim Act may also receive a percentage of any recovery, depending on whether the government chooses to intervene. See Mich. Comp. Laws Serv a.; Mich. Comp. Laws et seq.

23 Minnesota: Minnesota does not have a civil false claims act, but it does have a law making medical assistance fraud a crime. The law provides that any person who presents to the state agency a claim for reimbursement, a cost report or a rate application relating to the payment of medical assistance funds, which is false in whole or in part, is guilty of an attempt to commit theft of public funds and may be sentenced accordingly. The individual must have the intent to defraud. See Minn. Stat In addition, Minnesota has a law preventing employers from discharging employees who report a crime. Specifically, an employer cannot discharge, discipline, threaten, otherwise discriminate against, or penalize an employee regarding the employee s compensation, terms, conditions, location, or privileges of employment because the employee, in good faith, reports a violation or suspected violation of any federal or state law to an employer, the government or a law enforcement official, or because the employee participates in an investigation against the employer or refuses to perform an action that he believes violates any law. However, the law does not permit an employee to make statements or disclosures knowing that they are false or that they are in reckless disregard of the truth. See id See Minn. Stat ; id

24 Mississippi: The Mississippi Medicare Fraud Control Act creates civil or criminal penalties for false claims and statements and affords whistleblower protections for certain activities. The Act is intended to prevent a person from using fraud to obtain benefits or payments (e.g., Medicare claims) from the state government. Under the statute, knowingly making false claims to the Mississippi Division of Medicaid may be a crime. Violations include: - knowingly making, presenting or causing a claim for Medicaid benefits that is false, fictitious or fraudulent; - conspiring to defraud the state in order to obtain payments; and - knowingly and willfully making, inducing or seeking to induce the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order to qualify, upon initial certification or upon recertification, to receive Medicaid benefits as a hospital, skilled nursing facility, intermediate care facility or home health agency. A person who violates the statute may be prosecuted criminally for a felony with up to five years in prison and up to a $50,000 fine. Violations of the statute may also result in civil liability to the state for three times the amount of damages that the state suffered as a result of the false claims. See Miss. Code Ann et seq.

25 Missouri: Missouri s fraud and abuse laws prohibit conduct similar to that addressed under the federal False Claims Act and Anti-kickback Statute, but the Missouri prohibitions apply to the submission of false or fraudulent claims when payment would be made specifically through a Missouri state funded medical assistance program ( MAP ), such as Medicaid. The state Attorney General may seek criminal penalties, including imprisonment and a fine in addition to repayment of the funds unlawfully obtained and investigative and prosecution costs. The state Attorney General may also bring a civil action against any person who receives a healthcare payment under a MAP as a result of a false statement, representation or concealment. Recovery may include civil penalties, plus up to three times the amount of the inappropriately received funds and costs. Only the state Attorney General can bring such actions; private individuals cannot file qui tam lawsuits under these provisions. Missouri fraud and abuse laws include whistleblower protections against workplace retaliation and allow for original source whistleblowers to share in the recovery unless the whistleblower participated in the act constituting the violation. See Mo. Rev. Stat

26 Montana: The Montana False Claims Act creates civil and criminal penalties for false claims and statements and allows certain whistleblower protections. The Act is intended to prevent a person from using fraud to obtain benefits or payments from a governmental entity. Under the statute, knowingly making false claims to the state may be a crime. Violations include: - knowingly presenting or causing to be presented to an officer or employee of the governmental entity a false or fraudulent claim for payment or approval; - knowingly making, using, or causing to be made or used a false record or statement to get a false or fraudulent claim paid for or approved by the governmental entity; and - conspiring to defraud the governmental entity by getting a false or fraudulent claim allowed or paid for by the governmental entity for medical assistance and failing to disclose the false claim to the state within a reasonable time. - A person who violates the Act will be liable to the state for up to three times the amount of damages sustained by the state and up to a $10,000 penalty for each violation. A violator may also be prosecuted criminally. Montana law also protects individuals who report or file claims reporting suspected fraud under the Act. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status; the amount of back pay, with interest; and compensation for special damages, including litigation costs and reasonable attorney fees. Individuals who file a lawsuit may also receive a percentage of any recovery. The percentage received varies depending on whether the government chooses to intervene. See Mont. Code. Ann et seq.

27 Nebraska: Nebraska law prohibits the knowing submission of false or fraudulent claims for payment of funds specifically by the state s medical assistance programs ( MAP ). Nebraska s False Medicaid Claims Act further prohibits the failure to disclose a benefit received as the result of the submission of a false claim. Specifically, Nebraska law provides that a person who later discovers that he or she has benefited inappropriately from the submission of a false claim, but does not disclose the false claim to the state within sixty days of that discovery, is in violation of Nebraska s False Medicaid Claims Act. Anyone who, acting on behalf of a provider, knowingly charges, solicits, accepts, or receives anything of value in addition to the amount legally payable under the MAP subjects themselves to civil liability under the False Medicaid Claims Act. A person also violates the False Medicaid Claims Act, and subjects themselves to civil liability and damages, by knowingly failing to maintain or to disclose or by destroying records considered necessary. The state Attorney General may bring an action seeking substantial civil penalties as well as triple recovery of excessive payments by the state s MAP plus the state s costs and attorney s fees. Only the state Attorney General can bring such actions; private individuals cannot file qui tam lawsuits under these provisions. There are no express whistleblower protection statutes in Nebraska. See Neb. Rev. Stat. Ann to

28 Nevada: The Nevada False Claims Law was enacted to prevent a person from using fraud to obtain benefits or payments from the state. Under the statute, knowingly making false claims to an employee or agent of the state may be a crime. Violations include: - knowingly making false statements in applying for state medical benefits; - conspiring to defraud the state by aiding another in obtaining medical benefits; - knowingly delivering less money or property than the amount for which the person receives a receipt; - knowingly receiving public property from someone who is not authorized to disburse the property; - knowingly concealing an obligation to transmit money or property to the state; or - knowingly benefiting from an unintentional false claim but failing to report doing so after discovering that the claim was false. A person who violates these laws shall be liable to the state for three times the amount of damages that the state suffered as a result of the false claims, a civil penalty of up to $10,000 per violation, and the state s litigation costs. Also, under Nevada law, protections exist for individuals who report or file claims related to suspected fraud. Employees who are discriminated against for lawfully reporting fraud are entitled to be returned to the position they were in before they were discriminated against. This may include reinstatement with the same seniority status; two times the amount of back pay, with interest; compensation for special damages, such as litigation costs; and punitive damages if appropriate. Individuals who file a lawsuit under the Nevada False Claims Act may also receive a percentage of any recovery, depending on whether the government chooses to intervene. See Nev. Rev. Stat. Ann et seq.