205.8467 Liability of violators -- Payment of penalties to Medicaid trust fund.

368 words·~2 min read·/ky/chapter-205/205-8467

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(1)Any provider who has been found by a preponderance of the evidence in an

administrative process, in conformity with any applicable federal regulations and

with due process protections, to have knowingly submitted or caused claims to be

submitted for payment for furnishing treatment, services, or goods under a medical

assistance program provided under this chapter, which payment the provider was

not entitled to receive by reason of a violation of this chapter, shall:

(a)Be liable for restitution of any payments received in violation of this chapter,

and interest at the maximum legal rate pursuant to KRS 360.010 in effect on

the date any payment was made, for the period from the date payment was

made to the date of repayment to the Commonwealth;

(b)Be liable for a civil payment in an amount up to three

(3)times the amount of

excess payments;

(c)Be liable for payment of a civil payment of five hundred dollars ($500) for

each false or fraudulent claim submitted for providing treatment, services, or

goods;

(d)Be liable for payment of legal fees and costs of investigation and enforcement

of civil payments; and

(e)Be removed as a participating provider in the Medical Assistance Program for

two

(2)months to six

(6)months for a first offense, for six

(6)months to one

(1)year for a second offense, and for one

(1)year to five

(5)years for a third

offense.

(2)Civil payments, interest, costs of investigation, and enforcement of the civil

remedies recovered on behalf of the Commonwealth under this section shall be

remitted to the State Treasurer for deposit in a Medicaid trust fund which is hereby

created and shall not lapse. Funds deposited in the Medicaid trust fund shall not be

spent until appropriated by the General Assembly for medical assistance services.

(3)The remedies under this section are separate from and cumulative to any other

administrative, civil, or criminal remedies available under federal or state law or

regulation.

(4)The Cabinet for Health and Family Services, in consultation with the Office of the

Attorney General, may promulgate administrative regulations, pursuant to KRS

Chapter 13A, for the administration of the civil payments contained in this section.