(a)Any person that presents or causes to be presented to an officer, employee, or agent of the District of Columbia a claim under the Medicaid program that is for a medical or other item or service that the person knows or has reason to know was not provided as claimed, or that requests a payment which may not be made under the program under which the claim was made, or is submitted in violation of an agreement between the person and the District of Columbia, shall be subject, in addition to any other penalties that may be prescribed by law, to a civil money penalty of not more than $2,000 for each item or service. In addition, the person shall be subject to an assessment of not more than twice the amount claimed for each item or service in place of the damages sustained by the District o
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(a) Any person that presents or causes to be presented to an officer, employee, or agent of the District of Columbia a claim under the Medicaid program that is for a medical or other item or service that the person knows or has reason to know was not provided as claimed, or that requests a payment which may not be made under the program under which the claim was made, or is submitted in violation of an agreement between the person and the District of Columbia, shall be subject, in addition to any other penalties that may be prescribed by law, to a civil money penalty of not more than $2,000 for each item or service. In addition, the person shall be subject to an assessment of not more than twice the amount claimed for each item or service in place of the damages sustained by the District of Columbia because of the claim.
(1) The Director may initiate a proceeding to determine whether to impose a civil money penalty or assessment under subsection (a) of this section, but only as authorized by the Corporation Counsel pursuant to procedures agreed upon by them.
(2) The Director shall not make a determination adverse to any person under subsection (a) of this section until the person has been given written notice and an opportunity for the determination to be made on the record after a hearing at which the person is entitled to be represented by counsel, to present witnesses, and to cross-examine witnesses against the person.
(c) In determining the amount or scope of any penalty or assessment imposed pursuant to subsection (a) of this section, the Director shall take into account the following:
(1) The nature of claims and the circumstances under which they were presented;
(2) The degree of culpability, history of prior offenses, and financial condition of the person presenting the claims; and
(3) Other matters as justice may require.
(d) Any person adversely affected by a determination under this section may obtain a review of the determination in the Court of Appeals of the District of Columbia in accordance with § 2-510 .
(e) Civil money penalties and assessments imposed under this section may be recovered in a civil action in the name of the District of Columbia by the Attorney General. The amount of the penalty or assessment, when finally determined, may be deducted from any sum then or later owing by the District of Columbia to the person against whom the penalty or assessment has been charged.
(f) A determination by the Director to impose a penalty or assessment under subsection (a) of this section shall be final unless timely appealed pursuant to subsection (d) of this section. Matters that were raised or that could have been raised in a hearing before the Director or in an appeal pursuant to subsection (d) of this section may not be raised as a defense to a civil action brought by the District of Columbia.
(g) Whenever the Director’s determination to impose a penalty or assessment under subsection (a) of this section becomes final, the Director shall notify the appropriate licensing agency or organization that the penalty or assessment has become final and also about the reasons for the penalty or assessment.
(h) Testimony in any civil proceeding pursuant to this chapter and the fruits of that testimony shall be inadmissible as evidence in a criminal trial except in a prosecution for perjury or false statement.
(1) There is established as a special fund the Medicaid Provider Fraud Reimbursement Fund ("Fund"), which shall be administered by the Mayor in accordance with paragraph (3) of this subsection.
(2) Amounts recovered under this section shall be deposited in the Fund.
(3) Money in the Fund shall be used to reimburse the Medicaid program when the payment from Medicaid funds that is being reimbursed:
(A) Was based on an instance of Medicaid provider fraud; or
(B) Should be or should have been paid by a third-party insurer.
(4) Any money remaining available in the Fund at the end of a fiscal year, as determined by the Chief Financial Officer in the fiscal year-end close, shall be transferred to the unassigned fund balance of the General Fund of the District of Columbia as part of the fiscal year-end close.