HOUSE BILL No. 5747

 

June 14, 2012, Introduced by Rep. Olumba and referred to the Committee on Families, Children, and Seniors.

 

     A bill to amend 1977 PA 72, entitled

 

"The medicaid false claim act,"

 

by amending sections 3, 4, 5, 6, 7, and 12 (MCL 400.603, 400.604,

 

400.605, 400.606, 400.607, and 400.612), section 6 as amended by

 

1984 PA 333 and sections 7 and 12 as amended by 2008 PA 421.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3. (1) A person shall not knowingly make or cause to be

 

made a false statement or false representation of a material fact

 

in an application for medicaid benefits.

 

     (2) A person shall not knowingly make or cause to be made a

 

false statement or false representation of a material fact for use

 

in determining rights to a medicaid benefit.

 

     (3) A person, who having knowledge of the occurrence of an

 

event affecting his initial or continued right to receive a

 

medicaid benefit or the initial or continued right of any other

 


person on whose behalf he has applied for or is receiving a

 

benefit, shall not conceal or fail to disclose that event with

 

intent to obtain a benefit to which the person or any other person

 

is not entitled or in an amount greater than that to which the

 

person or any other person is entitled.

 

     (4) A person who violates this section is guilty of a felony,

 

punishable by imprisonment of not more than 4 years, or a fine of

 

not more than $50,000.00 $57,500.00, or both.

 

     Sec. 4. A person who solicits, offers, or receives a kickback

 

or bribe in connection with the furnishing of goods or services for

 

which payment is or may be made in whole or in part pursuant to

 

under a program established under Act No. 280 of the Public Acts of

 

1939, as amended the social welfare act, 1939 PA 280, MCL 400.1 to

 

400.119b, who makes or receives the payment, or who receives a

 

rebate of a fee or charge for referring an individual to another

 

person for the furnishing of the goods and services is guilty of a

 

felony, punishable by imprisonment for not more than 4 years, or by

 

a fine of not more than $30,000.00 $34,500.00, or both.

 

     Sec. 5. (1) A person shall not knowingly and wilfully make, or

 

induce or seek 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 that the

 

institution or facility may qualify, upon initial certification or

 

upon recertification, as a hospital, skilled nursing facility,

 

intermediate care facility, or home health agency.

 

     (2) A person who violates this section is guilty of a felony,

 

punishable by imprisonment for not more than 4 years, or by a fine

 


of not more than $30,000.00 $34,500.00, or both.

 

     Sec. 6. (1) A person shall not enter into an agreement,

 

combination, or conspiracy to defraud the state by obtaining or

 

aiding another to obtain the payment or allowance of a false claim

 

under the social welfare act, Act No. 280 of the Public Acts of

 

1939, as amended, being sections 400.1 to 400.121 of the Michigan

 

Compiled Laws.1939 PA 280, MCL 400.1 to 400.119b.

 

     (2) A person who violates this section is guilty of a felony,

 

punishable by imprisonment for not more than 10 years, or by a fine

 

of not more than $50,000.00 $57,500.00, or both.

 

     Sec. 7. (1) A person shall not make or present or cause to be

 

made or presented to an employee or officer of this state a claim

 

under the social welfare act, 1939 PA 280, MCL 400.1 to 400.119b,

 

upon or against the state, knowing the claim to be false.

 

     (2) A person shall not make or present or cause to be made or

 

presented a claim under the social welfare act, 1939 PA 280, MCL

 

400.1 to 400.119b, that he or she knows falsely represents that the

 

goods or services for which the claim is made were medically

 

necessary in accordance with professionally accepted standards.

 

Each claim violating this subsection is a separate offense. A

 

health facility or agency is not liable under this subsection

 

unless the health facility or agency, pursuant to a conspiracy,

 

combination, or collusion with a physician or other provider,

 

falsely represents the medical necessity of the particular goods or

 

services for which the claim was made.

 

     (3) A person shall not knowingly make, use, or cause 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 pertaining to a claim presented under the social welfare act,

 

1939 PA 280, MCL 400.1 to 400.1196.

 

     (4) A person who violates this section is guilty of a felony

 

punishable by imprisonment for not more than 4 years or a fine of

 

not more than $50,000.00 $57,500.00, or both.

 

     Sec. 12. (1) A person who receives a benefit that the person

 

is not entitled to receive by reason of fraud or making a

 

fraudulent statement or knowingly concealing a material fact, or

 

who engages in any conduct prohibited by this statute, shall

 

forfeit and pay to the state the full amount received, and for each

 

claim a civil penalty of not less than $5,000.00 $5,750.00 or more

 

than $10,000.00 $11,500.00 plus triple the amount of damages

 

suffered by the state as a result of the conduct by the person.

 

     (2) A criminal action need not be brought against the person

 

for that person to be civilly liable under this section.