§ 108A-63. Medical assistance provider fraud. - North Carolina Statutes

§ 108A‑63.  Medicalassistance provider fraud.

(a)        It shall beunlawful for any provider of medical assistance under this Part to knowinglyand willfully make or cause to be made any false statement or representation ofa material fact:

(1)        In any applicationfor payment under this Part, or for use in determining entitlement to suchpayment; or

(2)        With respect to theconditions or operation of a provider or facility in order that such provideror facility may qualify or remain qualified to provide assistance under thisPart.

(b)        It shall beunlawful for any provider of medical assistance to knowingly and willfullyconceal or fail to disclose any fact or event affecting:

(1)        His initial orcontinued entitlement to payment under this Part; or

(2)        The amount ofpayment to which such person is or may be entitled.

(c)        Except as otherwiseprovided in subsection (e) of this section, any person who violates a provisionof this section shall be guilty of a Class I felony.

(d)        "Provider"shall include any person who provides goods or services under this Part and anyother person acting as an employee, representative or agent of such person.

(e)        In connection withthe delivery of or payment for benefits, items, or services under this Part, itshall be unlawful for any provider of medical assistance under this Part toknowingly and willfully execute, or attempt to execute, a scheme or artificeto:

(1)        Defraud the MedicalAssistance Program.

(2)        Obtain, by means offalse or fraudulent pretenses, representations, or promises of material fact,any of the money or property owned by, or under the custody or control of, theMedical Assistance Program.

A violation of this subsection isa Class H felony. A conspiracy to violate this subsection is a Class I felony.

(f)         It shall be unlawfulfor any provider, with the intent to obstruct, delay, or mislead aninvestigation of a violation of this section by the Attorney General's office,to knowingly and willfully make or cause to be made a false entry in, alter,destroy, or conceal, or make a false statement about a financial, medical, orother record related to the provision of a benefit, item, or service under thisPart.  (1979, c.510, s. 1; 1981, c. 275, s. 1; 2009‑554, s. 3.)