36-2905.04. Eligibility by fraud; penalties; enforcement; classification

A. A person shall not provide or cause to be provided false or fraudulent information to the state as part of an application for the system under section 36-2901, paragraph 6, subdivision (a).

B. A person who violates subsection A of this section, who is determined eligible for the system and who would have been ineligible for the system if the person had provided true and correct information is subject, in addition to any other penalties that may be prescribed by federal or state law, to a civil penalty of not to exceed the amount incurred by the system, including capitation payments, on behalf of the person. In addition, the person's eligibility may be discontinued in accordance with rules adopted by the director.

C. In addition to the requirements in state law, the medicaid fraud and abuse controls that are enacted under federal law apply to all persons eligible for the system and all contractors, noncontracting providers and subcontracted providers that provide services to persons who are eligible for the system.

D. The director shall make the determination to assess a civil penalty and is responsible for collection of the penalty. The director may adopt rules that prescribe procedures for the determination and collection of civil penalties. The director may compromise civil penalties imposed under this section in accordance with criteria established in rules.

E. The director shall adopt rules providing for the appeal of a decision by a person adversely affected by a determination made by the director under this section. The director's final decision is subject to judicial review in accordance with title 12, chapter 7, article 6.

F. Amounts paid by the state and recovered under this section shall be deposited in the state general fund, and any applicable federal share shall be returned to the United States department of health and human services.

G. If a civil penalty imposed pursuant to subsection D of this section is not paid, the state or the administration may file an action to collect the civil penalty in the superior court in Maricopa county. Matters that were raised or could have been raised in a hearing before the director or in an appeal pursuant to title 12, chapter 7, article 6 may not be raised as a defense to the civil action. An action brought pursuant to this subsection shall be initiated within six years after the date the claim is presented.

H. The department and contractors, subcontracted providers and noncontracting providers shall cooperate with the administration to prevent, discover and prosecute eligibility fraud.

I. A person who knowingly aids or abets another person pursuant to section 13-301, 13-302 or 13-303 in the commission of an offense under this section or section 13-3713 is guilty of a class 5 felony.