Prohibited Conduct in Health Care - Mo. Rev. Stat. §191.905

The state of Missouri extends federal laws prohibiting false statements and kickbacks in making claims for payment to all health care providers, not only those participating in state or federal medical assistance programs.  Specifically, the law prohibits any health care provider from making a false statement of a material fact to receive payment.  Prohibited conduct includes:

1. Knowingly presenting for payment a claim that is falsely represented as medically necessary;
2. Knowingly concealing an event that affects one’s right to have payment made under a medical assistance program for a health care service;
3. Knowingly failing to disclose a material fact with the intent to obtain a payment for a health care service to which the provider is not entitled to;
4. Knowingly presenting a claim for payment for which a lesser service was provided.

The law also prohibits any person from knowingly soliciting or receiving a kickback or any remuneration for referring an individual to a health care provider, or for the purchase or lease of health care.  The law also makes it illegal to offer or pay the remuneration for referrals or purchase of health care. The law lays out the various penalties for the commission of the prohibited acts. The law also provides a number of exceptions to these prohibitions. 

Related Laws:  V.A.M.S. 191.909; V.A.M.S. 191.910