Federal and State Program Integrity in Idaho
Federal and State Program Integrity in Idaho
| Subtopic | Statute/Regulation | Description |
|---|
| Investigations/audits of insurance claims data compared to services provided | Idaho Admin. Code r. 16.03.09.230, General Payment Procedures | Permits Idaho Medicaid recipients to obtain care from the participating provider of their choice. Requires providers to submit Medicaid claims to the... |
| Idaho Admin. Code r. 16.03.09.330, Provider’s Responsibility to Maintain Records | Requires providers to maintain records regarding expenditures, cost allocations processes, and revenues. Requires providers to allow an auditor to... |
| Reporting false claims | Idaho Admin. Code r. 16.03.09.807, Dental Services: Quality Assurance | Requires providers of dental services to Medicaid participants to comply with the quality assurance guidelines established by the Idaho Smiles... |
| Idaho Code Ann. § 56-227A, Provider Fraud — Criminal Penalty | Establishes criminal liability for providers that knowingly make false statements or representations or conceal facts in order to receive payment for... |
| Use of false information for eligibility purposes | Idaho Admin. Code r. 16.03.09.807, Dental Services: Quality Assurance | Requires providers of dental services to Medicaid participants to comply with the quality assurance guidelines established by the Idaho Smiles... |
| Idaho Code Ann. § 31-3511, Violations and Penalties | Classifies the provision of false or misleading information in connection with an application for medical assistance as a misdemeanor. Prohibits... | |
| Idaho Code Ann. § 56-227, Fraudulent Acts — Penalty | Defines public assistance fraud as including obtaining or helping someone obtain public assistance to which they are not entitled, selling property... |
| Other | Idaho Code Ann. § 56-226, Medicaid Fraud Control Unit | Establishes a Medicaid Fraud Control Unit (“MFCU”) within Idaho’s Office of the Attorney General. Grants the MFCU authority to... |
| Fraud and abuse provisions about Medicaid or Medicare: False claims submitted to Medicaid or Medicare | Idaho Code Ann. § 56-227A, Provider Fraud — Criminal Penalty | Establishes criminal liability for providers that knowingly make false statements or representations or conceal facts in order to receive payment for... |
| Idaho Code Ann. § 56-227B, Provider Fraud — Damages | Subjects providers that fraudulently obtain overpayments to civil damages in the amount of three times the overpayment. Attaches interest in the... |
| Penalties for false claims | Idaho Code Ann. § 56-227A, Provider Fraud — Criminal Penalty | Establishes criminal liability for providers that knowingly make false statements or representations or conceal facts in order to receive payment for... |
| Idaho Code Ann. § 56-227B, Provider Fraud — Damages | Subjects providers that fraudulently obtain overpayments to civil damages in the amount of three times the overpayment. Attaches interest in the... |
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