reglab/housing_qa huggingface dataset:
MD. Health - General Code Ann. §  2-501 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 5 - Health Program Integrity and Recovery Activities|Section 2-501 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices and result in unnecessary costs to a program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized health care standards.    (c)    “Claim” means a request or demand for money, property, or services made under contract or otherwise, by a contractor, grantee, provider, or other person seeking money for the provision of health services if:        (1)    The State or Department provides any portion of the money or property that is requested or demanded; or        (2)    The State or Department reimburses the contractor, grantee, provider, or other person for any portion of the money or property that is requested or demanded.    (d)    “Employee” means any individual who performs services for, or under the control or direction of, a provider for wages or other remuneration.    (e)    (1)    “Fraud” means an intentional material deception or misrepresentation made by a person with the knowledge that the deception or misrepresentation could result in some unauthorized benefit or payment.        (2)    “Fraud” includes any act that constitutes fraud under applicable State or federal law.    (f)    “Program” means the Medical Assistance Program, the Cigarette Restitution Fund Program, the Developmental Disabilities Administration, the Behavioral Health Administration, the Prevention and Health Promotion Administration, or any other unit of the Department that pays a provider for a service rendered or claimed to have been rendered to a recipient.    (g)    (1)    “Provider” means:            (i)    An individual licensed or certified under the Health Occupations Article to provide health care;            (ii)    A licensed facility that provides health care to individuals;            (iii)    Any other person who or entity that provides health care, products, or services to a program recipient; or            (iv)    A contractor, subcontractor, or vendor who directly or indirectly provides the Department or its recipients supplies, drugs, equipment, or services.        (2)    “Provider” does not include a State agency that receives grant funding from or through the Department if that agency has in place a corporate compliance program that meets departmental requirements.    (h)    “Recipient” means an individual who receives benefits under a program.    (i)    “Recovery” means the repayment of money to the Department by a provider through return, reimbursement, recoupment, withholding of future payments, offsets, or any other method.
MD. Health - General Code Ann. §  2-502 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 5 - Health Program Integrity and Recovery Activities|Section 2-502 - Office of Inspector General Established

    There is an Office of the Inspector General in the Department.
MD. Health - General Code Ann. §  2-503 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 5 - Health Program Integrity and Recovery Activities|Section 2-503 - Duties of Inspector General

    (a)    The Inspector General:        (1)    May investigate fraud, waste, and abuse of departmental funds;        (2)    Shall cooperate with and coordinate investigative efforts with the Medicaid Fraud Control Unit and where a preliminary investigation establishes a sufficient basis to warrant referral, shall refer such matters to the Medicaid Fraud Control Unit; and        (3)    Shall cooperate with and coordinate investigative efforts with departmental programs and other State and federal agencies to ensure a provider is not subject to duplicative audits.    (b)    (1)    The Inspector General or a designated Assistant Inspector General may subpoena any person or evidence, administer oaths, and take depositions and other testimony for the purpose of investigating fraud, waste, or abuse of departmental funds.        (2)    If a person fails to comply with a lawful order or subpoena issued under this subsection, on petition of the Inspector General or a designated Assistant Inspector General, a court of competent jurisdiction may compel:            (i)    Compliance with the order or subpoena; or            (ii)    Testimony or the production of evidence.
MD. Health - General Code Ann. §  2-504 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 5 - Health Program Integrity and Recovery Activities|Section 2-504 - Additional Duties

    The Inspector General, in collaboration with the appropriate departmental program, may:         (1)    Take necessary steps to recover any mistaken claims paid or payments obtained in error or fraudulent claims paid to or obtained by a provider; and        (2)    Take necessary steps to recover the cost of benefits mistakenly paid or obtained in error, or fraudulently paid to or obtained by a recipient.
MD. Health - General Code Ann. §  2-505 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 5 - Health Program Integrity and Recovery Activities|Section 2-505 - Civil Liability

    (a)    A person is not civilly liable for:        (1)    Making a report in good faith of fraud, waste, or abuse; or        (2)    Participating in any investigation related to fraud, waste, or abuse.    (b)    (1)    This subsection does not apply to an employee as defined in § 1-501(c) of the Health Occupations Article or a State employee.        (2)    A provider may not take a retaliatory action against an employee because the employee:            (i)    Discloses or threatens to disclose to a supervisor or to a public body an activity, policy, or practice of the provider that the employee reasonably believes is in violation of this subtitle or a regulation adopted under this subtitle;            (ii)    Provides information to, or testifies before, a public body conducting an investigation, hearing, or inquiry into a suspected violation by the provider under this subtitle or a regulation adopted under this subtitle; or            (iii)    Objects to or refuses to participate in any activity, policy, or practice that the employee reasonably believes is in violation of this subtitle or regulations adopted under this subtitle.        (3)    Any employee who is subject to an action in violation of paragraph (2) of this subsection may institute a civil action in the county where:            (i)    The alleged violation occurred;            (ii)    The employee resides; or            (iii)    The provider maintains its principal office in the State.        (4)    The action shall be brought within 1 year after the alleged violation of paragraph (2) of this subsection or within 1 year after the employee first became aware of the alleged violation of paragraph (1) of this subsection.        (5)    In any action brought under this subsection, a court may:            (i)    Issue an injunction to restrain continued violation of this subsection;            (ii)    Reinstate the employee to the same or an equivalent position held before the violation of paragraph (2) of this subsection;            (iii)    Remove any adverse personnel record entries based on or related to the violation of paragraph (2) of this subsection;            (iv)    Reinstate full fringe benefits and seniority rights;            (v)    Require compensation for lost wages, benefits, and other remuneration; and            (vi)    Assess reasonable attorney’s fees and other litigation expenses against:                1.    The provider, if the employee prevails; or                2.    The employee, if the court determines that the action was brought by the employee in bad faith and without basis in law or fact.        (6)    A provider shall:            (i)    Conspicuously display notices of its employee protections under this subsection; and            (ii)    Use appropriate means to inform its employees of the protections and obligations provided under this subsection.
MD. Health - General Code Ann. §  2-603 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 6 - False Claims Against State Health Plans and State Health Programs|Section 2-603 - Civil Action

    (a)    If the State finds that a person has violated or is violating § 2–602(a) of this subtitle, the State may file a civil action in a court of competent jurisdiction within the State against the person.    (b)    In filing a civil action under this section, the State may seek:        (1)    The penalties provided under § 2–602(b) of this subtitle; and        (2)    Subject to the guidelines set forth in § 2–605(a)(4) of this subtitle, court costs and attorney’s fees.
MD. Health - General Code Ann. §  2-606 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 6 - False Claims Against State Health Plans and State Health Programs|Section 2-606 - Private Cause of Action -- Restrictions

    (a)    No court in this State shall have jurisdiction over an action filed under § 2–604 of this subtitle against any member of the Legislative Branch or the Judiciary of the State, any member of the Governor’s Executive Council, the Attorney General, the Comptroller, or the State Treasurer if the action is based on evidence or information known to the State when the action was filed.    (b)    A civil action may not be brought under this subtitle by a person who is or was a public employee or public official if the allegations of the action are based substantially on:        (1)    Allegations of wrongdoing or misconduct that the person had a duty or obligation to report or investigate within the scope of the person’s public employment or office; or        (2)    Information or records to which the person had access as a result of the person’s public employment or office.    (c)    A person may not bring an action under § 2–604 of this subtitle that is based on allegations or transactions that are the subject of a civil suit or an administrative civil money penalty proceeding in which the State is already a party.    (d)    (1)    Except as provided in paragraphs (2) and (3) of this subsection, no court in this State shall have jurisdiction over an action filed under § 2–604 of this subtitle that is based on the public disclosure of allegations or transactions:            (i)    In a criminal, civil, or an administrative hearing;            (ii)    In a legislative or an administrative report, a hearing, an audit, or an investigation; or            (iii)    From the news media.        (2)    Paragraph (1) of this subsection does not apply if the action is initiated by a person who:            (i)    Has direct and independent knowledge of the information on which the allegations are based; and            (ii)    Has voluntarily provided the information to the State before filing an action under § 2–604 of this subtitle that is based on the information.        (3)    The State, through the Attorney General, may file a civil action under § 2–603 of this subtitle based on the public disclosure described in paragraph (1) of this subsection.    (e)    The State is not liable for expenses that a person incurs in bringing an action under § 2–604 of this subtitle.    (f)    A person who is or was employed by the State, a local government, or any other political subdivision of the State as an auditor, investigator, attorney, financial officer, or contracting officer may not bring an action under § 2–604 of this subtitle that is based on allegations or transactions that the person discovered or learned of while acting in the person’s capacity as an auditor, investigator, attorney, financial officer, or contracting officer for the State, local government, or other political subdivision of the State.
MD. Health - General Code Ann. §  2-608 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 6 - False Claims Against State Health Plans and State Health Programs|Section 2-608 - Notice of Protections and Obligations

    An employer shall:        (1)    Conspicuously display notices of the protections provided to and obligations required of its employees under this subtitle; and        (2)    Use any appropriate means to inform its employees of the protections and obligations provided under this subtitle.
MD. Health - General Code Ann. §  2-609 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 6 - False Claims Against State Health Plans and State Health Programs|Section 2-609 - Procedural Matters

    (a)    A civil action filed under this subtitle may not be filed after the later of:        (1)    6 years after the date on which the underlying violation of § 2–602(a) of this subtitle occurred; or        (2)    3 years after the date when facts material to the right of action are known by the relator, the State’s Inspector General, or the Director of the State’s Medicaid Fraud Control Unit or reasonably should have been known, but in no event more than 10 years after the date on which the underlying violation of § 2–602(a) of this subtitle is committed.    (b)    A civil action may be filed under this subtitle for activity that occurred prior to October 1, 2010, if the limitations period under subsection (a) of this section has not lapsed.    (c)    If the State elects to intervene and proceed with an action brought under this subtitle, the State, through the Office of the Attorney General, may:        (1)    File its own complaint; or        (2)    Amend the complaint of the person who brought the action to clarify, add detail to the complaint, or add additional claims to the complaint.    (d)    To the extent that the claim of the State arises out of the conduct, transactions, or occurrences set forth, or attempted to be set forth by a person, a State pleading relates back to the filing date of the complaint of the person who originally brought the action.    (e)    In an action filed under this subtitle, all essential elements of the cause of action, including damages, shall be proven by a preponderance of the evidence.    (f)    Notwithstanding any other provision of law or rule of procedure or evidence in the Maryland Rules, a final judgment rendered in favor of the State in any criminal proceeding charging fraud or false statements, whether on a verdict after trial or on a plea of guilty or nolo contendere, shall stop the defendant from denying the essential elements of the offense in any action filed under this subtitle that involves the same act, transaction, or occurrence as in the criminal proceeding.
MD. Health - General Code Ann. §  2-610 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 6 - False Claims Against State Health Plans and State Health Programs|Section 2-610 - In General

    (a)    Any remedy provided under this subtitle is in addition to any other appropriate legal or equitable relief provided under any other applicable State or federal statute or regulation.    (b)    (1)    The State shall make all reasonable efforts to coordinate any investigation of an alleged violation under this subtitle with any investigation conducted by the federal government involving the same violation.        (2)    The State’s objective shall be to avoid unnecessary duplication of effort on the part of the person alleged to have committed the violation and to minimize the burden of the investigation on the person.    (c)    The Comptroller shall deposit any civil penalty or damages collected under this subtitle in the General Fund of the State.    (d)    The Department or the Inspector General of the Department may adopt regulations to carry out the provisions of this subtitle.
MD. Health - General Code Ann. §  2-611 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 6 - False Claims Against State Health Plans and State Health Programs|Section 2-611 - Annual Reports

    (a)    Beginning October 1, 2010, the Inspector General of the Department and the Director of the Medicaid Fraud Control Unit in the Office of the Attorney General shall report annually to the General Assembly, in accordance with § 2–1257 of the State Government Article, the following information for the previous fiscal year:        (1)    The number of civil actions filed under this subtitle;        (2)    The number of civil actions under this subtitle in which a judgment was entered, whether by settlement or adjudication; and        (3)    The number of claims made by the State based on alleged violations of § 2–602(a) of this subtitle that are settled without the filing of a civil action under this subtitle.    (b)    Unless the action is under seal in accordance with § 2–604 of this subtitle, for each civil action reported under subsection (a)(1) or (2) of this section, the report shall state:        (1)    Whether the action was filed by the State or by a person on behalf of the State and, if filed by a person, whether the State intervened and proceeded with the action;        (2)    The name of the defendant and the following information about the defendant:            (i)    The number of employees and any other data relevant to the size of the defendant;            (ii)    The amount of payments made to the defendant in the year prior to the filing of the action from State health plans and, to the extent known by the Inspector General and the Medicaid Fraud Control Unit, from other sources; and            (iii)    Whether the defendant is a minority–owned business enterprise as defined by § 14–301 of the State Finance and Procurement Article;        (3)    A description of the violation or alleged violation of § 2–602 of this subtitle; and        (4)    The amount sought in the action and, if applicable, the amount for which the defendant is liable under a settlement agreement or court order.    (c)    For each claim reported under subsection (a)(3) of this section, the report shall state:        (1)    A description of the violation or alleged violation of § 2–602 of this subtitle;        (2)    The resolution of the claim;        (3)    The amount, if any, the person against whom the claim was made agreed to pay in settlement of the claim; and        (4)    The amount, if any, collected by the State.
MD. Health - General Code Ann. §  2-701 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 7 - Use of Extrapolation in Recovery of Health Claim Overpayments|Section 2-701 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Claim” has the meaning stated in § 2–501 of this title.    (c)    “Extrapolation” means the process of estimating an unknown value by projecting, with a calculated precision or margin of error, the results of the review of a sample to the universe from which the sample was drawn using a statistically valid sampling methodology.    (d)    “Federal government” means an agency of the United States government or a contractor retained by the agency of the United States government.    (e)    “Overpayment” means a payment that:        (1)    Is made by the Department to a provider for services or goods for which the provider submitted a claim to the Department;        (2)    Is found to be incorrect; and        (3)    Results in a payment greater than that to which the provider is entitled.    (f)    “Program” has the meaning stated in § 2–501 of this title.    (g)    “Provider” has the meaning stated in § 2–501 of this title.    (h)    “Statistically valid sampling methodology” means a methodology used for extrapolation that has a confidence level of 90% or greater and is validated by a statistician who possesses at least a master’s degree in statistics.    (i)    “Universe” means a defined population of claims submitted by a provider to the Department and paid to the provider by the Department during a specified time period.
MD. Health - General Code Ann. §  2-702 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 7 - Use of Extrapolation in Recovery of Health Claim Overpayments|Section 2-702 - Use of Extrapolation During Audits to Recover Overpayments

    (a)    Subject to the requirements of this subtitle, the Inspector General, or a contractor or an agent acting on behalf of the Inspector General, may use extrapolation during an audit to recover an overpayment from a provider if:        (1)    The federal government has also conducted an audit of the program for overpayment; and        (2)    The monetary recovery amount determined to be due by the program to the federal government is based on the federal government’s use of extrapolation.    (b)    An audit conducted by the Inspector General or a contractor or agent acting on behalf of the Inspector General under subsection (a) of this section shall be limited to the scope of the federal audit, including claims for the same audit time period and the same type of claims.
MD. Health - General Code Ann. §  2-703 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 7 - Use of Extrapolation in Recovery of Health Claim Overpayments|Section 2-703 - When Extrapolation Permitted

    (a)    On a finding of an overpayment to a provider, the Inspector General may not use extrapolation unless there is a determination of a sustained or high level of payment error, as defined by regulation.    (b)    When using extrapolation to determine an overpayment, the sample to be used may not include claims:        (1)    In which the alleged overpayment would have no fiscal impact on the entire sample;        (2)    That were submitted in accordance with the Department’s, Inspector General’s, or program’s directives, policies, guidelines, or regulations; or        (3)    That are the result of an unintentional overlap in services among unrelated providers caused by circumstances beyond the control of the provider that is subject to the audit, in which case the Inspector General may recover the original overpayment.
MD. Health - General Code Ann. §  2-704 (2021)
2021 Maryland Statutes|Health - General|Title 2 - Maryland Department of Health|Subtitle 7 - Use of Extrapolation in Recovery of Health Claim Overpayments|Section 2-704 - Methodology; Audit Team

    (a)    The Inspector General or a contractor or an agent of the Inspector General that conducts an audit under this subtitle in which extrapolation may be used shall:        (1)    Perform the audit in accordance with a methodology used by the federal government or conducted in accordance with Generally Accepted Auditing Standards (GAAS) and the Statement on Accounting Standards (SAS);        (2)    Use a statistically valid sampling methodology; and        (3)    Meet the following qualifications:            (i)    Have at least 3 years of auditing experience;            (ii)    Have experience in the procedural coding program used for the claim;            (iii)    Be familiar, either independently or through training by the provider, with the format and content of paper and electronic medical records and claim forms used by the provider; and            (iv)    Have general knowledge of the particular health care item or service that is the subject of the audit and the program rules that govern the health care item or service at the time the item or service was provided.    (b)    (1)    If the medical necessity of the claim is the subject of the audit, the entity that conducts the audit shall include as part of the audit team an individual licensed in the same health occupation as the provider.        (2)    The individual included in the audit team under paragraph (1) of this subsection shall have significant knowledge of the audited procedure but is not required to be in the same specialty or practice area as the audited provider.