Fraudulent Practices

Definitions.

Circumstances under which person is deemed to have knowledge of falsity or deemed to have made or caused certain action.

False charges, representations and statements

Invoices containing false information

Certain acts relating to offer, payment, transfer, acceptance or solicitation of additional value prohibited

Failure to maintain and make available necessary records

Conspiracy to commit prohibited acts.

Fraud

Provider of health care convicted of fraudulent practice prohibited from receiving or accepting payment for accident benefits

Civil penalties for person who receives payment or benefit to which person is not entitled.

False claim for payment: Withholding by insurer of payment to provider of health care