PRINTER'S NO. 1624

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1439

Session of

2023

INTRODUCED BY KAUFFMAN, PICKETT, FLICK, MOUL, ZIMMERMAN AND

GILLEN, JUNE 20, 2023

REFERRED TO COMMITTEE ON HUMAN SERVICES, JUNE 20, 2023

Control Unit Fund.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The act of June 13, 1967 (P.L.31, No.21), known

as the Human Services Code, is amended by adding a section to

read:

Section 1419. False or Fraudulent Medicaid Claims and Civil

Enforcement.--(a) With respect to false or fraudulent Medicaid

claims, a person who commits any of the following acts shall be

subject to the damages and civil penalties under subsection (b):

(3) Has possession, custody or control of public property or

money used or to be used by the Commonwealth and knowingly

delivers or causes to be delivered less than all of the money or

property within a reasonable time.

(4) Is authorized to make or deliver a document certifying

receipt of property used or to be used by the Commonwealth and

knowingly and with intent to defraud makes or delivers a receipt

that falsely represents the property used or to be used.

(5) Knowingly and with intent to defraud buys or receives as

a pledge of an obligation or debt property owned by the

Commonwealth from any person who lawfully may not sell or pledge

property to the Commonwealth.

(7) Knowingly and with intent to defraud fails to disclose a

fact, event or occurrence material to an obligation to pay or

transmit money or property to the Commonwealth.

(8) Is a beneficiary of an inadvertent submission of a false

claim, subsequently discovers the falsity of the claim and, with

intent to defraud, fails to disclose the false claim to the

Commonwealth within a reasonable time after discovery of the

false claim.

(9) Conspires to commit a violation of clause (1), (2), (3),

(1) up to three times the amount of damages which the

Commonwealth sustains because of the act of that person, taking

into account the severity of the violation and level of

cooperation by the person; and

(2) a civil penalty of up to five thousand dollars ($5,000)

for each violation.

(c) The following apply:

(1) A civil action under this section may not be brought

more than three years after the date on which the violation was

committed.

(2) In an action brought under this section, the

nolo contendere, shall estop the defendant from denying the

essential elements of the offense in an action which involves

the same transaction as in the criminal proceeding and which is

brought under this section.

(d) The Attorney General and the Inspector General shall

have concurrent authority to institute proceedings under this

section.

(e) The Attorney General or Inspector General may bring a

civil action under this section in Commonwealth Court.

(f) Notwithstanding any law to the contrary, Commonwealth

(g) The following apply:

(1) The Medicaid Fraud Control Unit Fund is established in

the State Treasury.

(2) All revenue derived from civil penalties related to

Medicaid under this article shall be deposited into the Medicaid

Fraud Control Unit Fund.

(3) The proceeds in the Medicaid Fraud Control Unit Fund

shall be appropriated solely for the purpose of expanding the

number of investigators in and capabilities of the Medicaid

Fraud Control Unit until the Attorney General certifies to the

Governor and General Assembly that the Medicaid Fraud Control

(1) A request or demand for money or property, whether under

contract or otherwise and regardless of whether the Commonwealth

has title to the money or property, which meets any of the

following:

(i) Is presented to an employee, officer or agent of the

Commonwealth.

(ii) Is made to a contractor, grantee or other recipient and

any portion of the money or property will be spent or used on

the Commonwealth's behalf or to advance a program or interest of

the Commonwealth, and the Commonwealth:

recipient for any portion of the money or property which is

requested or demanded.

(2) The term does not include requests or demands for money

or property the Commonwealth has paid to an individual as

compensation for employment or as an income subsidy with no

restrictions on the individual's use of the money or property.

(3) To the extent it is not connected to a request or demand

for money or property, a filing with a Commonwealth agency under

the Commonwealth's insurance laws may not constitute a claim.

"Knowingly" means whenever a person, with respect to

information, does any of the following:

property, such that the payment or receipt of the money or

property would not otherwise be made.

"Obligation" means an established duty, whether or not fixed,

arising from any of the following:

(1) An express or implied contract.

(2) A grantor-grantee relationship.

(3) A licensor-licensee relationship.

(4) A fee-based or similar relationship.

(5) A statute or regulation.

(6) The retention of an overpayment.