Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.14 - Fraud

Current through Register Vol. 51, No. 14, July 12, 2024
A. "Medicaid fraud"
				  means:
(1) Knowingly and willfully making or
				  causing to be made any false statement or representation of a material fact in
				  any application for any benefit or payment under a State plan established by
				  Title XIX of the Social Security Act of 1939;
(2) Knowingly and willfully making or causing
				  to be made any false statement or representation of a material fact for use in
				  determining rights to those benefits or payments;
(3) Having knowledge of the occurrence of any
				  event affecting:
(a) The initial or continued
				  right to those benefits or payments, or
(b) The initial or continued right to those
				  benefits or payments to any other individual in whose behalf an application has
				  been made or in whose behalf benefits or payments are being received, and
				  concealing or failing to disclose that event with an intent to secure
				  fraudulently those benefits or payments either in a greater amount or quantity
				  than is due or when benefits or payments are not authorized;
(4) Having made application to
				  receive or having received any of those benefits or payments for the use and
				  benefit of another, and knowingly and willfully converting any part of the
				  benefit or payment to a use other than for the use and benefit of that other
				  person;
(5) Fraudulently obtaining,
				  attempting to obtain, or aiding another person in obtaining or attempting to
				  obtain any drug product or any medical care, the benefit or payment of any part
				  of which is or may be made from federal or state funds under a state Medical
				  Assistance program, by use of:
(a) Fraud,
				  deceit, misrepresentation, or subterfuge,
(b) Forgery or alteration of a Medical
				  Assistance prescription, or
(c)
				  Concealment of any material fact or by the use of false names or
				  addresses;
(6)
				  Possession of a blank Medical Assistance prescription, unless possession is
				  authorized by:
(a) A contract or other power,
				  right, or permission to manufacture, store, transport, or distribute blank
				  prescriptions;
(b) A grant of a
				  rendering privilege as evidenced by the issuance of a rendering number by a
				  state Medical Assistance program by which one is authorized to prescribe
				  pharmaceutical products for Medical Assistance recipients if the authorization:
(i) To possess a blank Medical Assistance
				  prescription terminates 30 days after notice of suspension or termination of
				  provider status in a state Medical Assistance program or exhaustion of final
				  appeal rights, whichever is later, and
(ii) Does not extend to possession of blank
				  Medical Assistance prescriptions which have been obtained from a source not
				  authorized to distribute blank Medical Assistance prescriptions under
				  §S(6)(a) of this regulation;
(c) Performance of one's lawful duties as a
				  law enforcement officer or as one employed by a state Medical Assistance
				  program; or
(d) The Director,
				  Medical Care Compliance Administration;
(7) Possession of a Medical Assistance card
				  or Pharmacy Assistance card without the authorization of the person to whom the
				  card is issued, unless:
(a) Possession is
				  obtained by a provider without knowledge that the presenting party lacked
				  authorization;
(b) Possession is
				  pursuant to one's lawful duties as a law enforcement officer or as one employed
				  by a state Medical Assistance program; or
(c) Authorized by the Director, Medical Care
				  Compliance Administration;
(8) Manufacture, distribution, or possession
				  of a counterfeit Medical Assistance card, prescription blank, or Pharmacy
				  Assistance card except when possession is obtained:
(a) By a provider without knowledge that the
				  card or prescription blank is counterfeit; or
(b) Pursuant to one's lawful duties as a law
				  enforcement officer or as one employed by a state Medical Assistance program;
				  and
(9) Manufacture,
				  distribution, or possession of a provider identification plate used or capable
				  of use to imprint Medical Assistance prescriptions unless authorized by:
(a) A contract or other power, right, or
				  permission to manufacture, transport, distribute, handle, or possess the
				  plates;
(b) Issuance by a state
				  Medical Assistance program to the party in possession;
(c) Performance of one's lawful duties as a
				  law enforcement officer or as one employed by a state Medical Assistance
				  program; or
(d) The Director,
				  Medical Care Compliance Administration.