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Federal and State Program Integrity in Michigan

Michigan law has very strict laws regarding fraud and abuse under the Medicaid program.  The state has also established the Office of Health Services Inspector General (OHSIG) to combat fraud and abuse in Michigan’s health services programs.  OHSIG has very specific responsibilities involving investigations and inspection of records.1

Under Michigan law, a person that knowingly makes a false statement of material fact in applying for Medicaid benefits is guilty of a felony.2 Michigan law also dictates that a person receiving or offering a bribe in connection with Medicaid services3, agreeing to defraud the state by getting payment of a false claim under Medicaid4, making a false claim for Medicaid service to a state agent5, or making a false statement on the operations and conditions of a hospital, skilled nursing facility, intermediate care facility, or home health agency are actions constituting a felony.6  The law also sets forth penalties for violating the fraud and abuse provisions of Medicaid.  The penalties include repaying the state of Michigan the full amount received fraudulently, paying a penalty from $5,000 up to $10,000, and triple damages.7  In addition, Medicaid participating providers who engage in fraudulent activity are subject to disciplinary action by the Department of Community Health.8

 

Footnotes

  • 1. M.C.L.A. § 333.26368
  • 2. M.C.L.A. § 400.603
  • 3. M.C.L.A. § 400.604
  • 4. M.C.L.A. § 400.606
  • 5. M.C.L.A. § 400.607
  • 6. M.C.L.A. § 400.605
  • 7. M.C.L.A. §400.612
  • 8. M.C.L.A. §400.111e

 

Federal and State Program Integrity in Michigan

Subtopic Statute/Regulation Description
Investigations/audits of insurance claims data compared to services provided Mich. Comp. Laws Ann. § 333.26368 - Creation of office of health services inspector general; transfer of powers and duties necessary for office to perform duties from department of community health Michigan established the Office of Health Services Inspector General (OHSIG) for the purpose of combating fraud, waste, and abuse in Michigan’s...
Use of false information for eligibility purposes Mich. Comp. Laws Ann. § 400.111b - Requirements as condition of participation by provider As a condition of participation to provide Medicaid services, a provider must meet the following requirements: Comply with all state licensing...
False claims submitted to Medicaid Mich. Comp. Laws Ann. § 400.111e - Grounds for action by director The Director of the Department of Community Health may take the actions specified in M.C.L.A. §400.111d for the following: If the provider...
Fraud and abuse provisions about Medicaid or Medicare: Anti-kickback laws Mich. Comp. Laws Ann. § 400.603 - Application for, or determining rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make a false statement or false representation of material fact in an application for...
Mich. Comp. Laws Ann. § 400.604 - Furnishing of goods or services; kickbacks or bribes; payments or rebates for referrals; felony; penalty Under the Medicaid False Claims Act, a person who solicits, offers or receives a bribe in connection with services rendered under Medicaid or a...
Mich. Comp. Laws Ann. § 400.605 - Conditions or operation of institution or facility; false statement or false representation of material fact to qualify for certification or recertification; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make or seek to induce the making of a false statement or false representation of...
Mich. Comp. Laws Ann. § 400.606 - Obtaining payment or allowance of false claim; felony; penalty Under the Medicaid False Claims Act, it is illegal to enter into an agreement or conspiracy to defraud the State of Michigan by aiding or getting...
Mich. Comp. Laws Ann. § 400.607 - Making or presenting false claims or false record or statement; violations as separate offenses; liability of health facility or agency; violation as felony; penalty Under the Medicaid False Claims Act, it is illegal to knowingly make a false claim for Medicaid service to a state agent or to knowingly misrepresent...
Mich. Comp. Laws Ann. § 400.612 - Civil penalty for receiving benefit by reason of fraud, making fraudulent statement, knowingly concealing material fact, or engaging in prohibited conduct; criminal action not required Under the Medicaid False Claims Act, an individual who receives a benefit he or she is not entitled to receive by making a false statement or...
Fraud and abuse provisions about Medicaid or Medicare: False claims submitted to Medicaid or Medicare Mich. Comp. Laws Ann. § 400.603 - Application for, or determining rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make a false statement or false representation of material fact in an application for...
Mich. Comp. Laws Ann. § 400.605 - Conditions or operation of institution or facility; false statement or false representation of material fact to qualify for certification or recertification; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make or seek to induce the making of a false statement or false representation of...
Mich. Comp. Laws Ann. § 400.606 - Obtaining payment or allowance of false claim; felony; penalty Under the Medicaid False Claims Act, it is illegal to enter into an agreement or conspiracy to defraud the State of Michigan by aiding or getting...
Mich. Comp. Laws Ann. § 400.607 - Making or presenting false claims or false record or statement; violations as separate offenses; liability of health facility or agency; violation as felony; penalty Under the Medicaid False Claims Act, it is illegal to knowingly make a false claim for Medicaid service to a state agent or to knowingly misrepresent...
Mich. Comp. Laws Ann. § 400.612 - Civil penalty for receiving benefit by reason of fraud, making fraudulent statement, knowingly concealing material fact, or engaging in prohibited conduct; criminal action not required Under the Medicaid False Claims Act, an individual who receives a benefit he or she is not entitled to receive by making a false statement or...
Fraud and abuse provisions about Medicaid or Medicare: Laws prohibiting self-referrals Mich. Comp. Laws Ann. § 400.603 - Application for, or determining rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make a false statement or false representation of material fact in an application for...
Mich. Comp. Laws Ann. § 400.605 - Conditions or operation of institution or facility; false statement or false representation of material fact to qualify for certification or recertification; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make or seek to induce the making of a false statement or false representation of...
Mich. Comp. Laws Ann. § 400.606 - Obtaining payment or allowance of false claim; felony; penalty Under the Medicaid False Claims Act, it is illegal to enter into an agreement or conspiracy to defraud the State of Michigan by aiding or getting...
Mich. Comp. Laws Ann. § 400.607 - Making or presenting false claims or false record or statement; violations as separate offenses; liability of health facility or agency; violation as felony; penalty Under the Medicaid False Claims Act, it is illegal to knowingly make a false claim for Medicaid service to a state agent or to knowingly misrepresent...
Mich. Comp. Laws Ann. § 400.612 - Civil penalty for receiving benefit by reason of fraud, making fraudulent statement, knowingly concealing material fact, or engaging in prohibited conduct; criminal action not required Under the Medicaid False Claims Act, an individual who receives a benefit he or she is not entitled to receive by making a false statement or...
Penalties for false claims Mich. Comp. Laws Ann. § 400.603 - Application for, or determining rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make a false statement or false representation of material fact in an application for...
Mich. Comp. Laws Ann. § 400.604 - Furnishing of goods or services; kickbacks or bribes; payments or rebates for referrals; felony; penalty Under the Medicaid False Claims Act, a person who solicits, offers or receives a bribe in connection with services rendered under Medicaid or a...
Mich. Comp. Laws Ann. § 400.605 - Conditions or operation of institution or facility; false statement or false representation of material fact to qualify for certification or recertification; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make or seek to induce the making of a false statement or false representation of...
Mich. Comp. Laws Ann. § 400.606 - Obtaining payment or allowance of false claim; felony; penalty Under the Medicaid False Claims Act, it is illegal to enter into an agreement or conspiracy to defraud the State of Michigan by aiding or getting...
Mich. Comp. Laws Ann. § 400.607 - Making or presenting false claims or false record or statement; violations as separate offenses; liability of health facility or agency; violation as felony; penalty Under the Medicaid False Claims Act, it is illegal to knowingly make a false claim for Medicaid service to a state agent or to knowingly misrepresent...
Mich. Comp. Laws Ann. § 400.612 - Civil penalty for receiving benefit by reason of fraud, making fraudulent statement, knowingly concealing material fact, or engaging in prohibited conduct; criminal action not required Under the Medicaid False Claims Act, an individual who receives a benefit he or she is not entitled to receive by making a false statement or...
Reporting false claims Mich. Comp. Laws Ann. § 400.603 - Application for, or determining rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty Under the Medicaid False Claims Act, a person may not knowingly make a false statement or false representation of material fact in an application for...