2020 Arkansas Code
Title 5 - Criminal Offenses
Subtitle 4 - Offenses Against Property
Chapter 37 - Forgery and Fraudulent Practices
Subchapter 2 - Offenses Generally
§ 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. (1) Health insurance plans;

2. (2) Managed care organization plans;

3. (3) Risk-based provider plans;

4. (4) The Arkansas Medicaid Program;

5. (5) The Social Security Disability Insurance program; and

6. (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. (1) An application for membership or eligibility for a healthcare plan;

2. (2) A claim for payment or reimbursement as a member or provider in a healthcare plan; or

3. (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. (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. (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. (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. (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.