CHAPTER 23. IMPROPER PAYMENTS
IC 12-15-23
Chapter 23. Improper Payments
IC 12-15-23-1
Reasonable grounds to suspect that provider has receivedpayments to which it is not entitled; certification of evidence toMedicaid fraud control unit; exception
Sec. 1. Except as provided in section 2 of this chapter, if theadministrator of the office determines that there are reasonablegrounds to suspect that a provider has received payments that theprovider is not entitled to under Medicaid, the administrator shallcertify the evidence of the suspected activity to the state Medicaidfraud control unit established under IC 4-6-10.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-2
Agreement for overpayment to be deducted from subsequentpayments; authorization
Sec. 2. If the administrator determines that a provider has receivedpayments the provider is not entitled to, the administrator may enterinto an agreement with the provider stating that the amount of theoverpayment shall be deducted from subsequent payments to theprovider.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-3
Agreements to deduct overpayments from subsequent payments;interest provisions; other provisions
Sec. 3. An agreement under section 2 of this chapter:
(1) must include a provision for the collection of any interestdue from the provider on the amount of the overpayment; and
(2) may include any other provisions agreed to by theadministrator and the provider.
As added by P.L.2-1992, SEC.9. Amended by P.L.8-2005, SEC.3.
IC 12-15-23-4
Rules
Sec. 4. The secretary may adopt rules under IC 4-22-2 thatprovide procedures for the calculation of overpayments under thischapter.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-5
Discovery of overpayment; time for entering into agreement;certification of facts to Medicaid fraud control unit
Sec. 5. If the administrator and a provider fail to enter into anagreement not more than sixty (60) days after the administrator'sdiscovery of an overpayment, the administrator shall immediatelycertify the facts of the case to the Medicaid fraud control unitestablished under IC 4-6-10.As added by P.L.2-1992, SEC.9.
IC 12-15-23-6
Determination by Medicaid fraud control unit; certification offacts to prosecuting attorney; reference of matter to attorneygeneral
Sec. 6. (a) If the state Medicaid fraud control unit determines thatan action based on the state Medicaid fraud control unit'sinvestigations under the unit's authority under IC 4-6-10-1.5 ismeritorious, the unit shall certify the facts drawn from theinvestigation to the prosecuting attorney of the judicial circuit inwhich the crime may have been committed.
(b) The state Medicaid fraud control unit shall assist theprosecuting attorney in prosecuting an action under this section.
(c) A prosecuting attorney to whom facts are certified undersubsection (a) may refer the matter to the attorney general.
(d) If a matter has been referred to the attorney general undersubsection (c), the attorney general may:
(1) file an information in a court with jurisdiction over thematter in the county in which the offense is alleged to have beencommitted; and
(2) prosecute the alleged offense.
As added by P.L.2-1992, SEC.9. Amended by P.L.10-1994, SEC.5;P.L.73-2003, SEC.3; P.L.149-2006, SEC.1.
IC 12-15-23-7
Action by attorney general; reference to administrator
Sec. 7. The attorney general may do either of the following:
(1) Bring a civil action upon the facts certified to the attorneygeneral by the state Medicaid fraud control unit.
(2) Refer the matter to the administrator for appropriate actionunder IC 12-15-22.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-8
Civil action; finding in favor of attorney general; treble damages;civil penalties; reimbursement of investigation costs
Sec. 8. (a) Subject to subsection (b), if the court finds in favor ofthe attorney general in a civil action brought by the attorney generalunder section 7 of this chapter, the court may do the following:
(1) Award damages against the provider of not more than three(3) times the amount paid to the provider in excess of theamount that was legally due.
(2) Assess a civil penalty against the provider of not more thanfive hundred dollars ($500) for each instance of overpaymentfound by the court.
(3) Order the provider to reimburse the attorney general for thereasonable costs of the attorney general's investigation andenforcement action.
(4) Take any combination of the actions described in
subdivisions (1), (2), and (3).
(b) The court may only take action under subsection (a)(2) and(a)(3) if the provider knew or had reason to know that an item or aservice was not provided as claimed.
As added by P.L.2-1992, SEC.9. Amended by P.L.73-2003, SEC.4.
IC 12-15-23-9
Meritorious action; money recoverable exceeding cost of action
Sec. 9. In determining whether an action is meritorious, theattorney general may consider whether the amount of moneyrecoverable under the action would exceed the cost of the action.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-10
Action by attorney general; compromise
Sec. 10. An action brought under section 7 of this chapter may becompromised in the manner prescribed by IC 4-6-2-11.
As added by P.L.2-1992, SEC.9.