Medicaid fraud – Ohio Rev. Code Ann. § 2913.40

“Medicaid fraud”

The following acts will be considered Medicaid fraud:

• Making a false or misleading statement or representation to obtain reimbursement from the medical assistance program;
• Knowingly altering, falsifying, destroying, concealing, or removing any records (including medical records) that are necessary to fully disclose the nature of goods or services for which a claim was submitted within six years of receiving reimbursement; and
• Knowingly altering, falsifying, destroying, concealing or removing any records (including medical records) that are necessary to fully disclose all income and expenditures upon which reimbursement rates were based for that person within six years of receiving reimbursement.
• Accept different terms of a person’s provider agreement for goods and services provided under the Medicaid program
• Solicit, offer, or receive any kickback or rebate in connection with furnishing goods and services for which the Medicaid program provides reimbursement

Medicaid fraud is a first-degree misdemeanor.  The fraud may be considered a felony in the following circumstances:

• A fifth degree felony: the value of the funds fraudulently obtained is between $1,000 and $7,499;
• A fourth degree felony: the value of the funds fraudulently obtained is between $7,500 and $149,999; or
• A third degree felony: the value of the funds fraudulently obtained is $150,000 or more.

The cost of investigation and prosecution that a defendant must pay is in addition to other penalties.