§ 5-37-217 — Healthcare fraud

(a) As used in this section, "healthcare plan" means a publicly or privately funded program or organization that is formed to provide or pay for healthcare goods or services, including without limitation: (1) Health insurance plans; (2) Managed care organization plans; (3) Risk-based provider plans; (4) The Arkansas Medicaid Program; (5) The Social Security Disability Insurance program; and (6) The Medicare program. (b) A person commits healthcare fraud if, with a purpose to defraud a healthcare plan, the person provides materially false information or omits material information in support of: (1) An application for membership or eligibility for a healthcare plan; (2) A claim for payment or reimbursement as a member or provider in a healthcare plan; or (3) A prior claim for payment or to justify payments previously received from a healthcare plan for healthcare goods or services during the course of an audit or investigation conducted by the Office of Medicaid Inspector General or a healthcare oversight agency with jurisdiction to audit, investigate, or prosecute any form of healthcare fraud. (c) Healthcare fraud is a: (1) Class A misdemeanor if the aggregate amount of the healthcare fraud in any period of twelve (12) months is less than two thousand five hundred dollars ($2,500); (2) Class C felony if the aggregate amount of the healthcare fraud in any period of twelve (12) months is two thousand five hundred dollars ($2,500) or more but less than five thousand dollars ($5,000); (3) Class B felony if the aggregate amount of the healthcare fraud in any period of twelve (12) months is five thousand dollars ($5,000) or more but less than twenty-five thousand dollars ($25,000); and (4) Class A felony if the aggregate amount of the healthcare fraud in any period of twelve (12) months is twenty-five thousand dollars ($25,000) or more.

Legislative History

Amended by Act 2017, No. 978,§ 1, eff. 8/1/2017. Added by Act 2013, No. 1499,§ 1, eff. 7/1/2013.