PARRIS N. GLENDENING, Governor                             Ch. 713

FOR HEALTH CARE GOODS OR SERVICES, INCLUDING DEFRAUDING OR
ATTEMPTING TO DEFRAUD A MEDICAID HEALTH PLAN OF THE RIGHT TO HONEST
SERVICES; OR

(II) KNOWINGLY AND WILLFULLY MAKING A FALSE

REPRESENTATION IN CONNECTION WITH THE DELIVERY OF OR PAYMENT FOR
HEALTH CARE GOODS OR SERVICES THAT, IN WHOLE OR IN TART, ARE
REIMBURSED BY OR ARE A REQUIRED BENEFIT OF A MEDICAID HEALTH PLAN.

(II) KNOWINGLY AND WILLFULLY OBTAINING OR ATTEMPTING TO
OBTAIN, BY MEANS OF A FALSE REPRESENTATION, MONEY, PROPERTY, OR ANY
THING OF VALUE IN CONNECTION WITH THE DELIVERY OP OR PAYMENT FOR
HEALTH CARE SERVICES THAT, IN WHOLE OR IN PART, ARE REIMBURSED BY OR
ARE A REQUIRED BENEFIT OF A MEDICAID HEALTH PLAN.

(6) (7) "REPRESENTATION" INCLUDES AN ACKNOWLEDGMENT,
CERTIFICATION, CLAIM, RATIFICATION, OR REPORT OF DEMOGRAPHIC STATISTICS,
ENCOUNTER DATA, ENROLLMENT CLAIMS, FINANCIAL INFORMATION, HEALTH
CARE SERVICES AVAILABLE OR RENDERED, AND THE QUALIFICATIONS OF A
PERSON THAT IS RENDERING HEALTH CARE OR ANCILLARY SERVICES.

(7) (8) "SERIOUS BODILY INJURY' MEANS A BODILY INJURY THAT
INVOLVES:

(I)      A SUBSTANTIAL RISK OF DEATH;

(II)    EXTREME PHYSICAL PAIN;

(III)   PROTRACTED AND OBVIOUS DISFIGUREMENT; OR

(IV)   PROTRACTED LOSS OR IMPAIRMENT OF THE FUNCTION OF A
BODY PART, ORGAN, OR MENTAL FACULTY.

(B)     (1) A PERSON MAY NOT COMMIT MEDICAID HEALTH PLAN FRAUD.

(2)     IF THE VALUE OF THE MONEY, GOODS, OR SERVICES OR HEALTH
CARE SERVICES. OR OTHER GOODS OR SERVICES INVOLVED IS LESS THAN $500 IN THE
AGGREGATE, A PERSON WHO VIOLATES THIS SUBSECTION IS GUILTY OF A
MISDEMEANOR AND, ON CONVICTION, IS SUBJECT TO A FINE OF NOT MORE THAN
$50,000 OR IMPRISONMENT FOR NOT MORE THAN 3 YEARS OR BOTH.

(3)     IF THE VALUE OF THE MONEY, GOODS, OR SERVICES OR, HEALTH
CARE SERVICES, OR OTHER GOODS OR SERVICES INVOLVED IS $500 OR MORE IN THE
AGGREGATE, A PERSON WHO VIOLATES THIS SUBSECTION IS GUILTY OF A FELONY
AND, ON CONVICTION, IS SUBJECT TO A FINE OF NOT MORE THAN $100,000 OR
IMPRISONMENT FOR NOT MORE THAN 5 YEARS OR BOTH.

(C)     (1) A PERSON MAY NOT MAKE FALSE STATEMENTS REPRESENTATIONS
RELATING TO MEDICAID HEALTH PLANS.

(2) A PERSON WHO VIOLATES THIS SUBSECTION IS GUILTY OF A
MISDEMEANOR AND, ON CONVICTION, IS SUBJECT TO A FINE OF NOT MORE THAN
$50,000 OR IMPRISONMENT FOR NOT MORE THAN 3 YEARS OR BOTH.

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