2020 Colorado Revised Statutes
Title 25.5 - Health Care Policy And Financing
Article 4. Colorado Medical Assistance Act - General Medical Assistance
Section 25.5-4-305. False medicaid claims - liability for certain acts.

(1) Except as otherwise provided in subsection (2) of this section, a person is liable to the state for a civil penalty of not less than five thousand five hundred dollars and not more than eleven thousand dollars; except that these upper and lower limits on liability shall automatically increase to equal the civil penalty allowed under the federal "False Claims Act", 31 U.S.C. sec. 3729, et seq., if and as the penalties in such federal act may be adjusted for inflation as described in said act in accordance with the federal "Civil Penalties Inflation Adjustment Act of 1990", Pub. L. No. 101-410, plus three times the amount of damages that the state sustains because of the act of that person, if the person:

1. Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;

2. Knowingly makes, uses, or causes to be made or used a false record or statementmaterial to a false or fraudulent claim;

3. Has possession, custody, or control of property or money used, or to be used, by thestate in connection with the "Colorado Medical Assistance Act"and knowingly delivers, or causes to be delivered, less than all of the money or property;

4. Authorizes the making or delivery of a document certifying receipt of property used,or to be used, by the state in connection with the "Colorado Medical Assistance Act" and, intending to defraud the state, makes or delivers the receipt without completely knowing that the information on the receipt is true;

5. Knowingly buys, or receives as a pledge of an obligation or debt, public propertyfrom an officer or employee of the state in connection with the "Colorado Medical Assistance Act" who lawfully may not sell or pledge the property;

6. Knowingly makes, uses, or causes to be made or used, a false record or statementmaterial to an obligation to pay or transmit money or property to the state in connection with the "Colorado Medical Assistance Act", or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the state in connection with the "Colorado Medical Assistance Act";

7. Conspires to commit a violation of paragraphs (a) to (f) of this subsection (1).

(2) Notwithstanding the amount of damages authorized in subsection (1) of this section, for a person who violates subsection (1) of this section, the court may assess not less than twice the amount of damages that the state sustains because of the act of the person if the court finds that:

1. The person who committed the violation of subsection (1) of this section furnished tothe officials of the state responsible for investigating false claims violations all information about the violation known to the person and furnished said information within thirty days after the date on which the person first obtained the information;

2. At the time the person furnished the information about the violation to the state, acriminal prosecution, civil action, or administrative action had not commenced with respect to the violation and the person did not have actual knowledge of the existence of an investigation into the violation; and

3. The person fully cooperated with any investigation of the violation by the state.

3. A person violating this section shall also be liable to the state for the costs of a civilaction brought to recover any penalty or damages.

4. Any information furnished pursuant to subsection (2) of this section shall be exemptfrom disclosure under part 2 of article 72 of this title.

Source: L. 2006: Entire article added with relocations, p. 1839, § 7, effective July 1. L. 2010: Entire section R&RE, (SB 10-167), ch. 296, p. 1380, § 12, effective May 26. L. 2011: IP(1) amended, (HB 11-1303), ch. 264, p. 1168, § 66, effective August 10. L. 2013: IP(1) and (1)(a) amended, (SB 13-205), ch. 276, p. 1441, § 4, effective August 7.

Editor's note: This section is similar to former § 26-4-1103 (1) and (2) as they existed prior to 2006.

Cross references: For the legislative declaration in SB 10-167, see section 1 of chapter 296, Session Laws of Colorado 2010.