Provider prohibited acts - 55 Pa. Code § 1101.75

Providers enrolled in the medical assistance program may not commit the following acts:1

•         Knowingly or intentionally presenting a false or fraudulent claim or cost report for furnishing services or merchandise under medical assistance;
•         Knowingly presenting any claim or cost report for medically unnecessary services or merchandise under medical assistance;
•         Knowingly submitting false information in order to obtain greater compensation than that to which one is legally entitled for furnishing services or merchandise under medical assistance;
•         Knowingly submitting false information in order to obtain authorization for furnishing services or merchandise under medical assistance;
•         Submitting a duplicate claim for services, supplies or equipment for which the provider has already received or claimed reimbursement; and
•         Submitting a claim for services, supplies or equipment that were not rendered to a recipient.