2013 Indiana Code
TITLE 12. HUMAN SERVICES
ARTICLE 15. MEDICAID
CHAPTER 23. IMPROPER PAYMENTS
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IC 12-15-23
Chapter 23. Improper Payments
IC 12-15-23-1
Reasonable grounds to suspect that provider has received
payments to which it is not entitled; certification of evidence to
Medicaid fraud control unit; exception
Sec. 1. Except as provided in section 2 of this chapter, if the
administrator of the office determines that there are reasonable
grounds to suspect that a provider has received payments that the
provider is not entitled to under Medicaid, the administrator shall
certify the evidence of the suspected activity to the state Medicaid
fraud control unit established under IC 4-6-10.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-2
Agreement for overpayment to be deducted from subsequent
payments; authorization
Sec. 2. (a) If the office of the secretary of family and social
services or administrator of the office determines that a provider has
received payments the provider is not entitled to, the administrator
may enter into an agreement with the provider stating that the
amount of the overpayment shall be deducted from subsequent
payments to the provider.
(b) If the office of the secretary of family and social services or
the administrator of the office and the provider cannot come to an
agreement within sixty (60) days after it is determined that a provider
has received payments that the provider is not entitled to, the
administrator may recoup the amount of overpayment to the provider
claimed by the state from subsequent payments to the provider.
As added by P.L.2-1992, SEC.9. Amended by P.L.229-2011,
SEC.142.
IC 12-15-23-3
Agreements to deduct overpayments from subsequent payments;
interest provisions; other provisions
Sec. 3. An agreement under section 2 of this chapter:
(1) must include a provision for the collection of any interest
due from the provider on the amount of the overpayment; and
(2) may include any other provisions agreed to by the
administrator and the provider.
As added by P.L.2-1992, SEC.9. Amended by P.L.8-2005, SEC.3.
IC 12-15-23-4
Rules
Sec. 4. The secretary may adopt rules under IC 4-22-2 that
provide procedures for the calculation of overpayments under this
chapter.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-5
Discovery of overpayment; time for entering into agreement;
certification of facts to Medicaid fraud control unit
Sec. 5. If the administrator and a provider fail to enter into an
agreement not more than sixty (60) days after the administrator's
discovery of an overpayment, the administrator shall immediately
certify the facts of the case to the Medicaid fraud control unit
established under IC 4-6-10.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-6
Determination by Medicaid fraud control unit; certification of
facts to prosecuting attorney; reference of matter to attorney
general
Sec. 6. (a) If the state Medicaid fraud control unit determines that
an action based on the state Medicaid fraud control unit's
investigations under the unit's authority under IC 4-6-10-1.5 is
meritorious, the unit shall certify the facts drawn from the
investigation to the prosecuting attorney of the judicial circuit in
which the crime may have been committed.
(b) The state Medicaid fraud control unit shall assist the
prosecuting attorney in prosecuting an action under this section.
(c) A prosecuting attorney to whom facts are certified under
subsection (a) may refer the matter to the attorney general.
(d) If a matter has been referred to the attorney general under
subsection (c), the attorney general may:
(1) file an information in a court with jurisdiction over the
matter in the county in which the offense is alleged to have been
committed; and
(2) prosecute the alleged offense.
As added by P.L.2-1992, SEC.9. Amended by P.L.10-1994, SEC.5;
P.L.73-2003, SEC.3; P.L.149-2006, SEC.1.
IC 12-15-23-7
Action by attorney general; reference to administrator
Sec. 7. The attorney general may do either of the following:
(1) Bring a civil action upon the facts certified to the attorney
general by the state Medicaid fraud control unit.
(2) Refer the matter to the administrator for appropriate action
under IC 12-15-22.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-8
Civil action; finding in favor of attorney general; treble damages;
civil penalties; reimbursement of investigation costs
Sec. 8. (a) Subject to subsection (b), if the court finds in favor of
the attorney general in a civil action brought by the attorney general
under section 7 of this chapter, the court may do the following:
(1) Award damages against the provider of not more than three
(3) times the amount paid to the provider in excess of the
amount that was legally due.
(2) Assess a civil penalty against the provider of not more than
five hundred dollars ($500) for each instance of overpayment
found by the court.
(3) Order the provider to reimburse the attorney general for the
reasonable costs of the attorney general's investigation and
enforcement action.
(4) Take any combination of the actions described in
subdivisions (1), (2), and (3).
(b) The court may only take action under subsection (a)(2) and
(a)(3) if the provider knew or had reason to know that an item or a
service was not provided as claimed.
As added by P.L.2-1992, SEC.9. Amended by P.L.73-2003, SEC.4.
IC 12-15-23-9
Meritorious action; money recoverable exceeding cost of action
Sec. 9. In determining whether an action is meritorious, the
attorney general may consider whether the amount of money
recoverable under the action would exceed the cost of the action.
As added by P.L.2-1992, SEC.9.
IC 12-15-23-10
Action by attorney general; compromise
Sec. 10. An action brought under section 7 of this chapter may be
compromised in the manner prescribed by IC 4-6-2-11.
As added by P.L.2-1992, SEC.9.
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