0001| HOUSE BILL 377
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0002| 43RD LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, 1998
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0003| INTRODUCED BY
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0004| M. MICHAEL OLGUIN
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0005|
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0006|
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0007|
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0008| FOR THE HEALTH AND WELFARE REFORM COMMITTEE
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0009|
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0010| AN ACT
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0011| RELATING TO MEDICAID FRAUD; REDUCING A PENALTY FOR CONVICTION
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0012| OF A MISDEMEANOR IN CERTAIN CIRCUMSTANCES.
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0013|
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0014| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0015| Section 1. Section 30-44-7 NMSA 1978 (being Laws 1989,
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0016| Chapter 286, Section 7, as amended) is amended to read:
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0017| "30-44-7. MEDICAID FRAUD--DEFINED--PENALTIES.--
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0018| A. Medicaid fraud consists of:
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0019| (1) paying, soliciting, offering or
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0020| receiving:
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0021| (a) a kickback or bribe in connection
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0022| with the furnishing of treatment, services or goods for which
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0023| payment is or may be made in whole or in part under the
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0024| program, including an offer or promise to, or a solicitation
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0025| or acceptance by, a health care official of anything of value
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0001| with intent to influence a decision or commit a fraud
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0002| affecting a state or federally funded or mandated managed
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0003| health care plan;
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0004| (b) a rebate of a fee or charge made to
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0005| a provider for referring a recipient to a provider;
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0006| (c) anything of value, intending to
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0007| retain it and knowing it to be in excess of amounts authorized
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0008| under the program, as a precondition of providing treatment,
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0009| care, services or goods or as a requirement for continued
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0010| provision of treatment, care, services or goods; or
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0011| (d) anything of value, intending to
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0012| retain it and knowing it to be in excess of the rates
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0013| established under the program for the provision of treatment,
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0014| services or goods;
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0015| (2) providing with intent that a claim be
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0016| relied upon for the expenditure of public money:
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0017| (a) treatment, services or goods that
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0018| have not been ordered by a treating physician;
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0019| (b) treatment that is substantially
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0020| inadequate when compared to generally recognized standards
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0021| within the discipline or industry; or
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0022| (c) merchandise that has been
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0023| adulterated, debased or mislabeled or is outdated;
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0024| (3) presenting or causing to be presented for
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0025| allowance or payment with intent that a claim be relied upon
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0001| for the expenditure of public money any false, fraudulent,
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0002| excessive, multiple or incomplete claim for furnishing
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0003| treatment, services or goods; or
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0004| (4) executing or conspiring to execute a plan
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0005| or action to:
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0006| (a) defraud a state or federally funded
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0007| or mandated managed health care plan in connection with the
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0008| delivery of or payment for health care benefits, including
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0009| engaging in any intentionally deceptive marketing practice in
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0010| connection with proposing, offering, selling, soliciting or
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0011| providing any health care service in a state or federally
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0012| funded or mandated managed health care plan; or
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0013| (b) obtain by means of false or
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0014| fraudulent representation or promise anything of value in
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0015| connection with the delivery of or payment for health care
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0016| benefits that are in whole or in part paid for or reimbursed
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0017| or subsidized by a state or federally funded or mandated
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0018| managed health care plan. This includes representations or
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0019| statements of financial information, enrollment claims,
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0020| demographic statistics, encounter data, health services
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0021| available or rendered and the qualifications of persons
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0022| rendering health care or ancillary services.
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0023| B. Except as otherwise provided for in this
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0024| section regarding the payment of fines by an entity, whoever
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0025| commits medicaid fraud as described in Paragraph (1) or (3) of
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0001| Subsection A of this section is guilty of a fourth degree
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0002| felony and shall be sentenced pursuant to the provisions of
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0003| Section 31-18-15 NMSA 1978.
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0004| C. Except as otherwise provided for in this
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0005| section regarding the payment of fines by an entity, whoever
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0006| commits medicaid fraud as described in Paragraph (2) or (4) of
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0007| Subsection A of this section when the value of the benefit,
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0008| treatment, services or goods improperly provided is:
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0009| (1) not more than one hundred dollars ($100)
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0010| is guilty of a petty misdemeanor and shall be sentenced
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0011| pursuant to the provisions of Section 31-19-1 NMSA 1978;
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0012| (2) more than one hundred dollars ($100) but
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0013| not more than two hundred fifty dollars ($250) is guilty of a
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0014| misdemeanor and shall be sentenced pursuant to the provisions
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0015| of Section 31-19-1 NMSA 1978;
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0016| (3) more than two hundred fifty dollars
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0017| ($250) but not more than two thousand five hundred dollars
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0018| ($2,500) is guilty of a fourth degree felony and shall be
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0019| sentenced pursuant to the provisions of Section 31-18-15 NMSA
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0020| 1978;
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0021| (4) more than two thousand five hundred
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0022| dollars ($2,500) but not more than twenty thousand dollars
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0023| ($20,000) shall be guilty of a third degree felony and shall
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0024| be sentenced pursuant to the provisions of Section 31-18-15
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0025| NMSA 1978; and
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0001| (5) more than twenty thousand dollars
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0002| ($20,000) shall be guilty of a second degree felony and shall
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0003| be sentenced pursuant to the provisions of Section 31-18-15
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0004| NMSA 1978.
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0005| D. Except as otherwise provided for in this
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0006| section regarding the payment of fines by an entity, whoever
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0007| commits medicaid fraud when the fraud results in physical harm
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0008| or psychological harm to a recipient is guilty of a fourth
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0009| degree felony and shall be sentenced pursuant to the
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0010| provisions of Section 31-18-15 NMSA 1978.
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0011| E. Except as otherwise provided for in this
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0012| section regarding the payment of fines by an entity, whoever
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0013| commits medicaid fraud when the fraud results in great
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0014| physical harm or great psychological harm to a recipient is
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0015| guilty of a third degree felony and shall be sentenced
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0016| pursuant to the provisions of Section 31-18-15 NMSA 1978.
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0017| F. Except as otherwise provided for in this
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0018| section regarding the payment of fines by an entity, whoever
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0019| commits medicaid fraud when the fraud results in death to a
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0020| recipient is guilty of a second degree felony and shall be
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0021| sentenced pursuant to the provisions of Section 31-18-15 NMSA
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0022| 1978.
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0023| G. If the person who commits medicaid fraud is an
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0024| entity rather than an individual, the entity shall be subject
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0025| to a fine of not more than [fifty thousand dollars
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($50,000)] ten thousand dollars ($10,000) for each
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0002| misdemeanor and not more than two hundred fifty thousand
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0003| dollars ($250,000) for each felony."
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0004|
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