21-3846.Making a false claim to the medicaidprogram.(a) Making a false claim, statement, or representationto themedicaid program is, knowingly and with intent to defraud, engaging in apatternof making, presenting,submitting, offering or causing to be made, presented, submitted or offered:
(1) Any false or fraudulent claim for payment for any goods, service,item, facility, accommodation for which payment may be made, in whole orin part, under the medicaid program, whether or not the claimis allowed or allowable;
(2) any false or fraudulent statement or representation for use indetermining payments which may be made, in whole or in part, underthe medicaid program, whether or not the claim is allowed orallowable;
(3) any false or fraudulent report or filing which is or may be usedin computing or determining a rate of payment for any goods, service,item, facility or accommodation, for which payment may be made, inwhole or in part, under the medicaid program, whether or notthe claim is allowed or allowable;
(4) any false or fraudulent statement or representation made inconnection with any report or filing which is or may be used in computing ordetermining a rate of payment for any goods, service, item, facility oraccommodation for which payment may be made, in whole or in part,under the medicaid program, whether or not the claim isallowed or allowable;
(5) any statement or representation for use by another in obtaining anygoods, service, item, facility or accommodation for which payment may bemade, in whole or in part, under the medicaid program,knowing the statement or representation to be false, in whole or in part,by commission or omission, whether or not the claim is allowed orallowable;
(6) any claim for payment, for any goods, service, item, facility, oraccommodation, which is not medically necessary in accordance withprofessionally recognized parameters or as otherwise required by law, for whichpayment may be made,in whole or in part, under the medicaid program, whether ornot the claim is allowed or allowable; or
(7) any wholly or partially false or fraudulent book, record,document, data or instrument, which is required to be kept or which is kept asdocumentation for any goods, service, item, facility or accommodation or of any cost or expense claimed for reimbursement for any goods,service, item, facility or accommodation for which payment is, hasbeen, or can be sought, in whole or in part, under the medicaidprogram, whether or not the claim is allowed or allowable.
(8) Any wholly or partiallyfalse or fraudulent book, record, document, data or instrument to any properlyidentified law enforcement officer, any properly identified employee orauthorized representative of the attorney general, or to any properlyidentified employee or agent of the department of social andrehabilitation services, or its fiscal agent, in connection with any audit orinvestigation involving any claim for payment or rate of payment for any goods,service, item, facility or accommodation payable, in whole or in part, underthe medicaid program.
(9) Any false or fraudulent statement or representation made, with theintent to influence any acts or decision of anyofficial, employee or agent of a state or federal agency having regulatory oradministrative authority overthe Kansas medicaid program.
(b) (1) As defined by subsection (a)(1) through (a)(7), making a falseclaim, statement orrepresentation to themedicaid program where the aggregate amount of payments illegallyclaimed is $25,000 or more is a severity level 7, nonperson felony.
(2) As defined by subsection (a)(1) through (a)(7), making a false claim,statement orrepresentation to themedicaid program where the aggregate amount of payments illegallyclaimed is at least $1,000 but less than $25,000 is aseverity level 9,nonperson felony.
(3) As defined by subsection (a)(1) through (a)(7), making a false claim,statement or representation to themedicaid program where the aggregate amount of payments illegallyclaimed is less than $1,000 is a class A misdemeanor.
(4) As defined by subsections (a)(8) and (a)(9), making a false claim,statementor representation to the medicaid program is a severity level 9, nonpersonfelony.
(c) In determining what is medically necessary pursuant to subsection(a)(6) of this section the attorney general may contract with or consult withqualified health care providers and other qualified individuals to identifyprofessionally recognized parameters for the diagnosis or treatment of therecipient's condition, illness or injury.
History: L. 1996, ch. 267, § 3;L. 2006, ch. 194, § 21; May 25.
21-3846.Making a false claim to the medicaidprogram.(a) Making a false claim, statement, or representationto themedicaid program is, knowingly and with intent to defraud, engaging in apatternof making, presenting,submitting, offering or causing to be made, presented, submitted or offered:
(1) Any false or fraudulent claim for payment for any goods, service,item, facility, accommodation for which payment may be made, in whole orin part, under the medicaid program, whether or not the claimis allowed or allowable;
(2) any false or fraudulent statement or representation for use indetermining payments which may be made, in whole or in part, underthe medicaid program, whether or not the claim is allowed orallowable;
(3) any false or fraudulent report or filing which is or may be usedin computing or determining a rate of payment for any goods, service,item, facility or accommodation, for which payment may be made, inwhole or in part, under the medicaid program, whether or notthe claim is allowed or allowable;
(4) any false or fraudulent statement or representation made inconnection with any report or filing which is or may be used in computing ordetermining a rate of payment for any goods, service, item, facility oraccommodation for which payment may be made, in whole or in part,under the medicaid program, whether or not the claim isallowed or allowable;
(5) any statement or representation for use by another in obtaining anygoods, service, item, facility or accommodation for which payment may bemade, in whole or in part, under the medicaid program,knowing the statement or representation to be false, in whole or in part,by commission or omission, whether or not the claim is allowed orallowable;
(6) any claim for payment, for any goods, service, item, facility, oraccommodation, which is not medically necessary in accordance withprofessionally recognized parameters or as otherwise required by law, for whichpayment may be made,in whole or in part, under the medicaid program, whether ornot the claim is allowed or allowable; or
(7) any wholly or partially false or fraudulent book, record,document, data or instrument, which is required to be kept or which is kept asdocumentation for any goods, service, item, facility or accommodation or of any cost or expense claimed for reimbursement for any goods,service, item, facility or accommodation for which payment is, hasbeen, or can be sought, in whole or in part, under the medicaidprogram, whether or not the claim is allowed or allowable.
(8) Any wholly or partiallyfalse or fraudulent book, record, document, data or instrument to any properlyidentified law enforcement officer, any properly identified employee orauthorized representative of the attorney general, or to any properlyidentified employee or agent of the department of social andrehabilitation services, or its fiscal agent, in connection with any audit orinvestigation involving any claim for payment or rate of payment for any goods,service, item, facility or accommodation payable, in whole or in part, underthe medicaid program.
(9) Any false or fraudulent statement or representation made, with theintent to influence any acts or decision of anyofficial, employee or agent of a state or federal agency having regulatory oradministrative authority overthe Kansas medicaid program.
(b) (1) As defined by subsection (a)(1) through (a)(7), making a falseclaim, statement orrepresentation to themedicaid program where the aggregate amount of payments illegallyclaimed is $25,000 or more is a severity level 7, nonperson felony.
(2) As defined by subsection (a)(1) through (a)(7), making a false claim,statement orrepresentation to themedicaid program where the aggregate amount of payments illegallyclaimed is at least $1,000 but less than $25,000 is aseverity level 9,nonperson felony.
(3) As defined by subsection (a)(1) through (a)(7), making a false claim,statement or representation to themedicaid program where the aggregate amount of payments illegallyclaimed is less than $1,000 is a class A misdemeanor.
(4) As defined by subsections (a)(8) and (a)(9), making a false claim,statementor representation to the medicaid program is a severity level 9, nonpersonfelony.
(c) In determining what is medically necessary pursuant to subsection(a)(6) of this section the attorney general may contract with or consult withqualified health care providers and other qualified individuals to identifyprofessionally recognized parameters for the diagnosis or treatment of therecipient's condition, illness or injury.
History: L. 1996, ch. 267, § 3;L. 2006, ch. 194, § 21; May 25.
21-3846.Making a false claim to the medicaidprogram.(a) Making a false claim, statement, or representationto themedicaid program is, knowingly and with intent to defraud, engaging in apatternof making, presenting,submitting, offering or causing to be made, presented, submitted or offered:
(1) Any false or fraudulent claim for payment for any goods, service,item, facility, accommodation for which payment may be made, in whole orin part, under the medicaid program, whether or not the claimis allowed or allowable;
(2) any false or fraudulent statement or representation for use indetermining payments which may be made, in whole or in part, underthe medicaid program, whether or not the claim is allowed orallowable;
(3) any false or fraudulent report or filing which is or may be usedin computing or determining a rate of payment for any goods, service,item, facility or accommodation, for which payment may be made, inwhole or in part, under the medicaid program, whether or notthe claim is allowed or allowable;
(4) any false or fraudulent statement or representation made inconnection with any report or filing which is or may be used in computing ordetermining a rate of payment for any goods, service, item, facility oraccommodation for which payment may be made, in whole or in part,under the medicaid program, whether or not the claim isallowed or allowable;
(5) any statement or representation for use by another in obtaining anygoods, service, item, facility or accommodation for which payment may bemade, in whole or in part, under the medicaid program,knowing the statement or representation to be false, in whole or in part,by commission or omission, whether or not the claim is allowed orallowable;
(6) any claim for payment, for any goods, service, item, facility, oraccommodation, which is not medically necessary in accordance withprofessionally recognized parameters or as otherwise required by law, for whichpayment may be made,in whole or in part, under the medicaid program, whether ornot the claim is allowed or allowable; or
(7) any wholly or partially false or fraudulent book, record,document, data or instrument, which is required to be kept or which is kept asdocumentation for any goods, service, item, facility or accommodation or of any cost or expense claimed for reimbursement for any goods,service, item, facility or accommodation for which payment is, hasbeen, or can be sought, in whole or in part, under the medicaidprogram, whether or not the claim is allowed or allowable.
(8) Any wholly or partiallyfalse or fraudulent book, record, document, data or instrument to any properlyidentified law enforcement officer, any properly identified employee orauthorized representative of the attorney general, or to any properlyidentified employee or agent of the department of social andrehabilitation services, or its fiscal agent, in connection with any audit orinvestigation involving any claim for payment or rate of payment for any goods,service, item, facility or accommodation payable, in whole or in part, underthe medicaid program.
(9) Any false or fraudulent statement or representation made, with theintent to influence any acts or decision of anyofficial, employee or agent of a state or federal agency having regulatory oradministrative authority overthe Kansas medicaid program.
(b) (1) As defined by subsection (a)(1) through (a)(7), making a falseclaim, statement orrepresentation to themedicaid program where the aggregate amount of payments illegallyclaimed is $25,000 or more is a severity level 7, nonperson felony.
(2) As defined by subsection (a)(1) through (a)(7), making a false claim,statement orrepresentation to themedicaid program where the aggregate amount of payments illegallyclaimed is at least $1,000 but less than $25,000 is aseverity level 9,nonperson felony.
(3) As defined by subsection (a)(1) through (a)(7), making a false claim,statement or representation to themedicaid program where the aggregate amount of payments illegallyclaimed is less than $1,000 is a class A misdemeanor.
(4) As defined by subsections (a)(8) and (a)(9), making a false claim,statementor representation to the medicaid program is a severity level 9, nonpersonfelony.
(c) In determining what is medically necessary pursuant to subsection(a)(6) of this section the attorney general may contract with or consult withqualified health care providers and other qualified individuals to identifyprofessionally recognized parameters for the diagnosis or treatment of therecipient's condition, illness or injury.
History: L. 1996, ch. 267, § 3;L. 2006, ch. 194, § 21; May 25.
