In Pennsylvania, if the Department of Public Welfare determines that a health care provider participating in the Medicaid program has submitted a false claim for payment, the provider will be referred to the Department of Justice for further investigation.  Any provider that is then convicted by a federal court of willfully defrauding the Medicaid program is subject to a $25,000 fine and up to five years imprisonment.1  Other fraudulent acts committed by providers, such as soliciting kickbacks or bribes, may bring convictions for second or third degree felonies bringing fines between $15,000 and $25,000 and a criminal sentence of 7 – 10 years.2  Additionally, if a provider is suspected of inappropriately billing for services from Medicaid, the Department of Public Welfare can delay or suspend payment on the provider’s invoices for up to 120 days pending a review of the billing patterns.3

        If a provider submits fraudulent claims to the state’s PACE program, he or she is subject to criminal sanctions as well as a financial penalty three times the value of any material gain received as a result of the offense.4