Federal and State Program Integrity

Rhode Island addresses the integrity of federal and state programs by prohibiting various acts of health care fraud,1 including submitting false claims for payment and making false statements to obtain medical assistance.2 Penalties for such fraud range from a $5,000 fine to a $10,000 fine and/or 10 years imprisonment.3  Rhode Island also provides a variety of remedies for person injured by over-billing4 or health care fraud including suing for damages5 or an injunction6 in civil court. Persons that report information about health care fraud, in good faith, are immune from resulting liability.7

Provider that commit Medicaid fraud8 may have their medical assistance payments suspended while a judge may permanently bar such providers or suspend their participation in the Medicaid program for a maximum of 2 years.9 Additionally, providers may not make or receive health care referrals in return for payment or other remuneration10 and must disclose their financial interest in a health care facility when referring patients to that facility.11

Rhode Island prohibits persons from making false statements in relation to the certification of a health care facility.12

Insurance claim forms and applications must contain a statement warning individuals about the penalties for presenting false claims.13