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Provider fraud - 55 Pa. Code § 1101.4

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If the department of public welfare determines after an investigation that a provider participating in the medical assistance program has submitted claims for payments he was not otherwise entitled to receive, the department will refer the case record to the Medicaid Fraud Control Unit of the Department of Justice for further investigation and possible referral for prosecution.  Providers who are convicted by a federal court of willfully defrauding the Medicaid program are subject to a $25,000 fine and/or up to five years imprisonment.

Current as of June 2015