Provider prohibited acts; criminal penalties and civil remedies - 62 Pa. Stat. Ann. § 1407

The following acts are considered unlawful:

• Knowingly or intentionally presenting a false or fraudulent claim or cost report for furnishing services or merchandise under medical assistance;
• Knowingly presenting any claim or cost report for medically unnecessary services or merchandise under medical assistance;
• Knowingly submitting false information in order to obtain greater compensation than that to which one is legally entitled for furnishing services or merchandise under medical assistance;
• Knowingly submitting false information in order to obtain authorization for furnishing services or merchandise under medical assistance;
• Submitting a duplicate claim for services, supplies or equipment for which the provider has already received or claimed reimbursement; and
• Submitting a claim for services, supplies or equipment that were not rendered to a recipient.

Any person who commits any of these acts will be guilty of a third degree felony, punishable by a fine of $15,000 and seven years imprisonment.  Subsequent offenses are second degree felonies, punishable by a fine of $25,000 and ten years imprisonment.  Any person convicted of such acts must repay the amount of excess benefits or payments, plus interest, and up to three times the amount of excess benefits or payments.  Any action taken by the department against a provider will be forwarded to the Medicaid Fraud Control Unit of the Department of Justice and to the appropriate licensing board of the department of state.