Arkansas Code of 1987 (2023) › Title 5 - CRIMINAL OFFENSES (§§ 5-1-101 — 5-79-101) › Subtitle 5 - OFFENSES AGAINST THE ADMINISTRATION OF GOVERNMENT (§§ 5-51-201 — 5-56-101) › Chapter 55 - FRAUD AGAINST THE GOVERNMENT (§§ 5-55-101 — 5-55-602) › Subchapter 1 - MEDICAID FRAUD ACT (§§ 5-55-101 — 5-55-115) › Section 5-55-111 - Criminal acts constituting Medicaid fraud

A person commits Medicaid fraud when he or she:
(1)
Purposely makes or causes to be made any omission or false statement or representation of a material fact in any claim, request for payment, or application for any benefit or payment under the Arkansas Medicaid Program;
(2)
At any time purposely makes or causes to be made any omission or false statement or representation of a material fact for use in determining rights to a benefit or payment under the Arkansas Medicaid Program;
(3)
Having knowledge of the occurrence of any event affecting his or her initial or continued right to any benefit or payment under the Arkansas Medicaid Program, or the initial or continued right to any benefit or payment under the Arkansas Medicaid Program of any other individual in whose behalf he or she has applied for or is receiving the benefit or payment under the Arkansas Medicaid Program, purposely conceals or fails to disclose the event with an intent fraudulently to secure the benefit or payment under the Arkansas Medicaid Program either in a greater amount or quantity than is due or when no benefit or payment under the Arkansas Medicaid Program is authorized;
(4)
Having made or submitted a claim, request for payment, or application to receive any benefit or payment under the Arkansas Medicaid Program for the use and benefit of another person and having received it, purposely converts the benefit or payment under the Arkansas Medicaid Program or any part of the benefit or payment under the Arkansas Medicaid Program to a use other than for the use and benefit of the other person;
(5)
Purposely presents or causes to be presented a claim for a service required to be provided by a person with a particular type of license or credential while knowing that the individual who furnished the service was not licensed or credentialed;
(6)
Purposely solicits or receives any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind:
(A)
In return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under the Arkansas Medicaid Program; or
(B)
In return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under the Arkansas Medicaid Program;
(7)
(A)
Purposely offers or pays any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind, to any person to induce that person to:
(i)
Refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under the Arkansas Medicaid Program; or
(ii)
Purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under the Arkansas Medicaid Program.
(B)
If the transaction is otherwise legal and properly documented as occurring in the normal course of business, subdivisions (7)(A)(i) and (ii) of this section do not apply to:
(i)
A discount or other reduction in price obtained by a provider of services or other entity under the Arkansas Medicaid Program if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under the Arkansas Medicaid Program;
(ii)
Any amount paid by an employer to an employee who has a bona fide employment relationship with the employer for employment in the provision of covered items or services;
(iii)
Any amount paid by a vendor of goods or services to a person authorized to act as a purchasing agent for a group of individuals or entities who are furnishing services reimbursed under the Arkansas Medicaid Program if:
(a)
The person has a written contract with each individual or entity that specifies the amount to be paid to the person and the amount may be a fixed amount or a fixed percentage of the value of the purchases made by each individual or entity under the contract; and
(b)
In the case of an entity that is a provider of services as defined in §
20-9-101
, the person discloses in such form and manner as the Secretary of the Department of Human Services requires to the entity and, upon request, to the secretary, the amount received from each vendor with respect to purchases made by or on behalf of the entity; or
(iv)
Any payment practice specified by the secretary promulgated pursuant to applicable federal or state law;
(8)
Purposely makes or causes to be made, or induces or seeks to induce, any omission or false statement or representation of a material fact with respect to the conditions or operation of any institution, facility, or Medicaid provider in order that the institution, facility, or Medicaid provider may qualify to obtain or maintain any licensure or certification when the licensure or certification is required to be enrolled or eligible to deliver any healthcare goods or services to Medicaid recipients by state law, federal law, or the rules of the Arkansas Medicaid Program;
(9)
Purposely:
(A)
Charges, for any service provided to a patient under the Arkansas Medicaid Program, money or other consideration at a rate in excess of the rates established by the state; or
(B)
Charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under the Arkansas Medicaid Program, any gift, money, donation, or other consideration other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient:
(i)
As a precondition of admitting a patient to a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities; or
(ii)
As a requirement for the patient's continued stay in a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities when the cost of the services provided in the hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities to the patient is paid for in whole or in part under the Arkansas Medicaid Program;
(10)
Purposely makes or causes to be made any false statement or representation of a material fact in any application for a benefit or payment in violation of the rules and provider agreements issued by the Arkansas Medicaid Program or its fiscal agents;
(11)
Knowingly submits false documentation or makes or causes to be made or induces or seeks to induce any material false statement to the Office of Medicaid Inspector General or the Medicaid Fraud Control Unit within the office of the Attorney General during an audit or in response to a request for information or a subpoena;
(12)
Purposely forges the signature of a doctor, nurse, or other medical professional on a prescription, referral for healthcare goods or services, or finding of medical necessity for any Medicaid recipient of the Arkansas Medicaid Program;
(13)
Knowingly submits a forged prescription, referral for healthcare goods or services, or finding of medical necessity for:
(A)
Payment under the Arkansas Medicaid Program; or
(B)
An audit or in response to a request for information or a subpoena to the Office of Medicaid Inspector General or the Medicaid Fraud Control Unit within the office of the Attorney General; or
(14)
Purposely places a false entry in a medical chart, medical record, or any record of services required to be made to the Arkansas Medicaid Program that indicates that healthcare goods or services have been provided to a Medicaid recipient knowing that the healthcare goods or services were not provided.
Amended by Act 2019, No. 315,§ 152, eff. 7/24/2019.
Amended by Act 2019, No. 916,§ 8, eff. 7/24/2019.
Amended by Act 2019, No. 916,§ 7, eff. 7/24/2019.
Amended by Act 2019, No. 916,§ 6, eff. 7/24/2019.
Amended by Act 2019, No. 910,§ 5130, eff. 7/1/2019.
Amended by Act 2019, No. 910,§ 5129, eff. 7/1/2019.
Amended by Act 2017, No. 978,§ 6, eff. 8/1/2017.
Acts 1993, No. 1291, § 6.