A BILL TO BE ENTITLED AN ACT TO PROHIBIT THE REGULAR BUSINESS PRACTICE OF WAIVING REQUIRED MEDICAID AND HEALTH CHOICE RECIPIENT CO-PAYMENTS BY CERTAIN PROVIDERS.
Amends GS 108A-63 (Medical Assistance Provider Fraud) making it illegal for any provider under the Medicaid Program (Medicaid) to knowingly and willfully execute, solicit, receive, or attempt to execute, by scheme or artifice, a waiver of co-payments owed by recipients of medical assistance under Medicaid, with the intent to induce recipients to purchase, lease, or order items or services. Also makes other quid pro quo arrangements for items or services under Medicaid illegal.
A medical provider that does so will be found in violation of this subsection unless the co-payment in question was waived, in full or partially, for any of the following reasons: (1) the waiver is authorized under Medicaid, (2) the provider decides on an individual basis that the collection of the co-payment amount would place a substantial financial hardship on the recipient, or (3) the provider has made a good faith effort to collect the co-payment but the reasonable efforts fail. A conviction under this subsection will result in a suspension or termination of the provider's participation in Medicaid.
Makes conforming changes.
Effective December 1, 2013, and applies to acts and offenses committed on or after that date.
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