§ 108A-70.12. Liability for certain acts; damages; effect of repayment. - North Carolina Statutes

§ 108A‑70.12.  Liabilityfor certain acts; damages; effect of repayment.

(a)        Liability forCertain Acts. – It shall be unlawful for any provider of medical assistanceunder the Medical Assistance Program to:

(1)        Knowingly present,or cause to be presented to the Medical Assistance Program a false orfraudulent claim for payment or approval; or

(2)        Knowingly make, use,or cause to be made or used a false record or statement to get a false orfraudulent claim paid or approved by the Medical Assistance Program.

Each claim presented or causedto be presented in violation of this section is a separate violation.

(b)        Damages. –

(1)        Except as providedin subdivision (2) of this subsection, a court shall assess against anyprovider of medical assistance under the Medical Assistance Program whoviolates this section a civil penalty of not less than five thousand dollars($5,000) and not more than ten thousand dollars ($10,000) plus three times theamount of damages which the Medicaid Assistance Program sustained because ofthe act of the provider.

(2)        A court may assess apenalty of not less than two times the amount of damages which the MedicalAssistance Program sustains because of the act of the provider if a court findsthat:

a.         The providercommitting a violation of this section furnished officials of the Stateresponsible for investigating false claims violations with all informationknown to the provider about the violation within 30 days after the date theprovider first obtained the information;

b.         The provider fullycooperated with any State investigation of the violation; and

c.         At the time theprovider furnished the State with the information about the violation, nocriminal prosecution, civil action, or administrative action had commenced withrespect to the violation, and the provider did not have actual knowledge of theexistence of an investigation into the violation.

(3)        In addition to thedamages and penalty assessed by the court pursuant to subdivision (1) or (2) ofthis subsection, a provider violating this section shall also be liable for thecosts of a civil action brought to recover any penalty or damages, interest onthe damages at the maximum legal rate in effect on the date the payment wasmade to the provider for the period from the date upon which payment was madeto the provider to the date upon which repayment is made by the provider to theMedical Assistance Program, and the costs of the investigation.

(4)        As applied toproviders that are subject to certification review by the Division of HealthService Regulation, a violation of Medicaid provider certification standards inproviding a service, good, or accommodation shall not be considered anindependent basis for liability under this Act. However, liability may beimposed if a false or fraudulent claim is presented as set forth in subsection(a) of this section in connection with that service, good, or accommodation.

(c)        Effect ofRepayment. – Intent to repay or repayment of any amounts obtained by a provideras a result of any acts described in subsection (a) of this section shall notbe a defense to or grounds for dismissal of an action brought pursuant to thissection. However, a court may consider any repayment in mitigation of theamount of any penalties assessed. (1997‑338, s. 1; 2007‑182, s. 1.)