(a) A person commits healthcare fraud if with a purpose to defraud a health plan:
(1) The person knowingly provides materially false information or omits material information for the purpose of requesting payment from a single health plan for a health care item or service; and
(2) As a result of the materially false information or omission of material information, a person receives payment in an amount that the person is not entitled to under the circumstances.
(b) (1) Healthcare fraud is a Class A misdemeanor.
(2) However, if on one (1) or more occasions, the payment or portion of the payment wrongfully received from a single health plan in a period of not more than one (1) year exceeds:
(A) Ten thousand dollars ($10,000) in the aggregate, healthcare fraud is a Class D felony;
(B) Twenty-five thousand dollars ($25,000) in the aggregate, healthcare fraud is a Class C felony;
(C) Fifty thousand dollars ($50,000) in the aggregate, healthcare fraud is a Class B felony; or
(D) One million dollars ($1,000,000) in the aggregate, healthcare fraud is a Class A felony.
(c) It is an affirmative defense to prosecution under this section that the defendant was a clerk, bookkeeper, or other employee other than an employee charged with the active management and control in an executive capacity of the affairs of the corporation who executed the orders of his or her employer or of a superior employee generally authorized to direct his or her activities.
Section: Previous 5-37-208 5-37-209 5-37-210 5-37-211 5-37-212 5-37-213 5-37-214 5-37-215 5-37-216 5-37-217 5-37-225 5-37-226 5-37-227 5-37-228 NextLast modified: November 15, 2016