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H0436........................................................by MR. SPEAKER
Requested by: Department of Health and Welfare
MEDICAL ASSISTANCE - FALSE CLAIMS - Repeals and adds to existing law to
provide treble damages and civil penalties for false claims for medical
assistance.
01/12 House intro - 1st rdg - to printing
01/12 Rpt prt - to Health/Wel
H0436|||| LEGISLATURE OF THE STATE OF IDAHO |||| Fifty-fourth Legislature Second Regular Session - 1998IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 436 BY MR. SPEAKER Requested by: Department of Health and Welfare 1 AN ACT 2 RELATING TO CLAIMS FOR MEDICAL ASSISTANCE; REPEALING SECTION 56-227B, IDAHO 3 CODE; AND AMENDING CHAPTER 2, TITLE 56, IDAHO CODE, BY THE ADDITION OF A 4 NEW SECTION 56-227E, IDAHO CODE, TO IMPOSE LIABILITY FOR SUBMISSION OF 5 FALSE OR FRAUDULENT CLAIMS TO THE STATE FOR MEDICAL ASSISTANCE PAYMENTS, 6 AND TO SET FORTH CIVIL PENALTIES FOR SUCH CONDUCT. 7 Be It Enacted by the Legislature of the State of Idaho: 8 SECTION 1. That Section 56-227B, Idaho Code, be, and the same is hereby 9 repealed. 10 SECTION 2. That Chapter 2, Title 56, Idaho Code, be, and the same is 11 hereby amended by the addition thereto of a NEW SECTION , to be 12 known and designated as Section 56-227E, Idaho Code, and to read as follows: 13 56-227E. FALSE CLAIMS. (1) Civil liability for certain acts. Any person 14 who, in connection with the state's medical assistance program: 15 (a) Knowingly presents, or causes to be presented, to an officer, agent 16 or employee of the state a false or fraudulent claim for payment or 17 approval; 18 (b) Knowingly makes, uses, or causes to be made or used, a false record 19 or statement to get a false or fraudulent claim paid or approved by the 20 state; 21 (c) Conspires to defraud the state by getting a false or fraudulent claim 22 allowed or paid; 23 (d) Has possession, custody, or control of property or money used, or to 24 be used, by the state, and intending to defraud the state or to conceal 25 the property, delivers or causes to be delivered less property than the 26 amount for which the person receives a certificate or receipt; 27 (e) Is authorized to make or deliver a document certifying receipt of 28 property used or to be used by the state and, with intent to defraud the 29 state, makes or delivers the receipt without knowledge that the informa- 30 tion on the receipt is true; or 31 (f) Knowingly makes, uses, or causes to be made or used, a false record 32 or statement to conceal, avoid or decrease an obligation to pay or trans- 33 mit money or property to the state, 34 is liable to the state for a civil penalty of not less than five thousand dol- 35 lars ($5,000) and not more than ten thousand dollars ($10,000), plus three (3) 36 times the amount of damages which the state sustains because of the act of 37 that person. A person who violates this section shall also be liable to the 38 state for costs incurred to recover any such penalties or damages, including 39 costs of investigation and attorney's fees. 40 (2) Reduced penalty for cooperation. The court may assess not less than 41 two (2) times the amount of damages which the state of Idaho sustains because 42 of the act of the person if the court finds that: 2 1 (a) The person committing a violation of this subsection furnished the 2 department of health and welfare with all information known to such person 3 about the violation within thirty (30) days after the date on which the 4 defendant first obtained the information; 5 (b) Such person fully cooperated with any investigation of such viola- 6 tion; and 7 (c) At the time such person furnished the state with the information 8 about the violation, no criminal prosecution, civil action or administra- 9 tive action had commenced under this title with respect to such violation, 10 and the person did not have actual knowledge of the existence of an inves- 11 tigation into such violation. 12 (3) Damages to include federal share. Any amounts attributed to federal 13 funding shall be included when determining the amount of damages sustained by 14 the state. 15 (4) Action by the attorney general. The attorney general may bring a 16 civil action under this section. 17 (5) Burden of proof. The state shall be required to prove all essential 18 elements of the cause of action, including damages, by a preponderance of the 19 evidence. 20 (6) Definitions. For purposes of this section: 21 (a) "Claim" means any request or demand for payment of items or services 22 under the state's medical assistance program, whether under a contract or 23 otherwise. It includes claims made to a contractor, grantee or other 24 recipient if the state provides any portion of the money or property which 25 is requested or demanded, or if the state will reimburse such contractor, 26 grantee or other recipient for any portion of the money or property which 27 is requested or demanded. 28 (b) "Knowingly" means that a person, with respect to information: 29 (i) Has actual knowledge of the information; 30 (ii) Acts in deliberate ignorance of the truth or falsity of the 31 information; or 32 (iii) Acts in reckless disregard of the truth or falsity of the 33 information and no proof of specific intent to defraud is required. 34 (c) "Person" means any natural person, partnership, corporation, associa- 35 tion or other legal entity.
STATEMENT OF PURPOSE
RS07299C1
In accordance with the Governor's Medicaid Reform Initiatives, this legislation is intended to
strengthen the state's ability to combat false claims submitted under the state's medical
assistance program. Patterned after the federal false claims statute, it provides for treble
damages and civil penalties where the state can prove a violation of the statute. The state may
also recover the costs incurred in pursuing the action, including costs of investigation and
attorney's fees.
FISCAL IMPACT
The legislation is expected to result in no additional cost to the state.
CONTACT
Name: Kathleen Allyn
Agency: Department of Health and Welfare
Phone: 334-5747
Statement of Purpose/Fiscal Impact
H 436