HOUSE BILL No. 6496

 

 

November 27, 2018, Introduced by Rep. Noble and referred to the Committee on Law and Justice.

 

     A bill to amend 1977 PA 72, entitled

 

"The medicaid false claim act,"

 

by amending section 7 (MCL 400.607), as amended by 2008 PA 421.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 7. (1) A person shall not make, or present, or cause to

 

be made or presented to an employee or officer of this state a

 

claim under the social welfare act, 1939 PA 280, MCL 400.1 to

 

400.119b, upon or against the state, knowing the claim to be false.

 

     (2) A person shall not make, or present, or cause to be made

 

or presented a claim under the social welfare act, 1939 PA 280,

 

MCL 400.1 to 400.119b, that he or she knows falsely represents that

 

the goods or services for which the claim is made were medically

 

necessary in accordance with professionally accepted standards.

 

Each claim violating this subsection is a separate offense. A

 

health facility or agency is not liable under this subsection

unless the health facility or agency, pursuant according to a

 

conspiracy, combination, or collusion with a physician or other

 

provider, falsely represents the medical necessity of the

 

particular goods or services for which the claim was made.

 

     (3) A person shall not knowingly make, use, or cause to be

 

made or used a false record or statement to conceal, avoid, or

 

decrease an obligation to pay or transmit money or property to the

 

state pertaining to a claim presented under the social welfare act.

 

     (4) A person who violates this section is guilty of a felony

 

punishable by imprisonment for not more than 4 years or a fine of

 

not more than $50,000.00, or both.

 

     (4) If the amount of the false or fraudulent claim is less

 

than $1,000.00, the person is guilty of a misdemeanor punishable by

 

imprisonment for not more than 1 year or a fine of not more than

 

$2,000.00 or 3 times the amount of the false or fraudulent claim,

 

whichever is greater, or both imprisonment and a fine.

 

     (5) If any of the following apply, the person is guilty of a

 

felony punishable by imprisonment for not more than 5 years or a

 

fine of not more than $10,000.00 or 3 times the amount of the false

 

or fraudulent claim, whichever is greater, or both imprisonment and

 

a fine:

 

     (a) The amount of the false or fraudulent claim is $1,000.00

 

or more but less than $20,000.00.

 

     (b) The person violates subsection (4) and has 1 or more prior

 

convictions for committing or attempting to commit an offense under

 

this section.

 

     (6) If any of the following apply, the person is guilty of a

felony punishable by imprisonment for not more than 10 years or a

 

fine of not more than $15,000.00 or 3 times the amount of the false

 

or fraudulent claim, whichever is greater, or both imprisonment and

 

a fine:

 

     (a) The amount of the false or fraudulent claim is $20,000.00

 

or more but less than $50,000.00.

 

     (b) The person violates subsection (4) or (5) and has 2 or

 

more prior convictions for committing or attempting to commit an

 

offense under this section.

 

     (7) If the amount of the false or fraudulent claim is

 

$50,000.00 or more but less than $100,000.00, the person is guilty

 

of a felony punishable by imprisonment for not more than 15 years

 

or a fine of not more than $25,000.00 or 3 times the amount of the

 

false or fraudulent claim, whichever is greater, or both

 

imprisonment and a fine.

 

     (8) If the amount of the false or fraudulent claim is

 

$100,000.00 or more, the person is guilty of a felony punishable by

 

imprisonment for not more than 20 years or a fine of not more than

 

$50,000.00 or 3 times the amount of the false or fraudulent claim,

 

whichever is greater, or both imprisonment and a fine.

 

     (9) The amount of the false or fraudulent claims submitted in

 

separate incidents according to a scheme or course of conduct may

 

be aggregated to determine the total amount of the false or

 

fraudulent claim submitted.

 

     (10) If the prosecuting attorney intends to seek an enhanced

 

sentence based on the defendant having 1 or more prior convictions,

 

the prosecuting attorney shall include on the complaint and

information a statement listing the prior conviction. The existence

 

of the defendant's prior conviction shall be determined by the

 

court, without a jury, at sentencing or at a separate hearing for

 

that purpose before sentencing. The existence of a prior conviction

 

may be established by any evidence relevant for that purpose,

 

including, but not limited to, 1 or more of the following:

 

     (a) A copy of the judgment of conviction.

 

     (b) A transcript of a prior trial, plea-taking, or sentencing.

 

     (c) Information contained in a presentence report.

 

     (d) The defendant's name.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.