Ohio Code 2913.401 – Medicaid eligibility fraud
(A) As used in this section:
Attorney's Note
Under the Ohio Code, punishments for crimes depend on the classification. In the case of this section:| Class | Prison | Fine |
|---|---|---|
| Felony of the third degree | 9 months to 5 years | up to $10,000 |
| Felony of the fourth degree | 6 to 18 months | up to $5,000 |
| Felony of the fifth degree | 6 to 12 months | up to $2,500 |
| Misdemeanor of the first degree | up to 180 days | up to $1,000 |
Terms Used In Ohio Code 2913.401
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Fraud: Intentional deception resulting in injury to another.
- Irrevocable trust: A trust arrangement that cannot be revoked, rescinded, or repealed by the grantor.
- Person: includes an individual, corporation, business trust, estate, trust, partnership, and association. See Ohio Code 1.59
- Personal property: All property that is not real property.
- Property: means real and personal property. See Ohio Code 1.59
- Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
- Revocable trust: A trust agreement that can be canceled, rescinded, revoked, or repealed by the grantor (person who establishes the trust).
- Services: include labor, personal services, professional services, rental services, public utility services including wireless service as defined in division (F)(1) of section 128. See Ohio Code 2913.01
- United States: includes all the states. See Ohio Code 1.59
- Whoever: includes all persons, natural and artificial; partners; principals, agents, and employees; and all officials, public or private. See Ohio Code 1.02
(1) “Medicaid services” has the same meaning as in section 5164.01 of the Revised Code.
(2) “Property” means any real or personal property or other asset in which a person has any legal title or interest.
(B) No person shall knowingly do any of the following in an application for enrollment in the medicaid program or in a document that requires a disclosure of assets for the purpose of determining eligibility for the medicaid program:
(1) Make or cause to be made a false or misleading statement;
(2) Conceal an interest in property;
(3)(a) Except as provided in division (B)(3)(b) of this section, fail to disclose a transfer of property that occurred during the period beginning thirty-six months before submission of the application or document and ending on the date the application or document was submitted;
(b) Fail to disclose a transfer of property that occurred during the period beginning sixty months before submission of the application or document and ending on the date the application or document was submitted and that was made to an irrevocable trust a portion of which is not distributable to the applicant for or recipient of medicaid or to a revocable trust.
(C)(1) Whoever violates this section is guilty of medicaid eligibility fraud. Except as otherwise provided in this division, a violation of this section is a misdemeanor of the first degree. If the value of the medicaid services paid as a result of the violation is one thousand dollars or more and is less than seven thousand five hundred dollars, a violation of this section is a felony of the fifth degree. If the value of the medicaid services paid as a result of the violation is seven thousand five hundred dollars or more and is less than one hundred fifty thousand dollars, a violation of this section is a felony of the fourth degree. If the value of the medicaid services paid as a result of the violation is one hundred fifty thousand dollars or more, a violation of this section is a felony of the third degree.
(2) In addition to imposing a sentence under division (C)(1) of this section, the court shall order that a person who is guilty of medicaid eligibility fraud make restitution in the full amount of any medicaid services paid on behalf of an applicant for or recipient of medicaid for which the applicant or recipient was not eligible, plus interest at the rate applicable to judgments on unreimbursed amounts from the date on which the medicaid services were paid to the date on which restitution is made.
(3) The remedies and penalties provided in this section are not exclusive and do not preclude the use of any other criminal or civil remedy for any act that is in violation of this section.
(D) This section does not apply to a person who fully disclosed in an application for medicaid or in a document that requires a disclosure of assets for the purpose of determining eligibility for medicaid all of the interests in property of the applicant for or recipient of medicaid, all transfers of property by the applicant for or recipient of medicaid, and the circumstances of all those transfers.
(E) Any amounts of medicaid services recovered as restitution under this section and any interest on those amounts shall be credited to the general revenue fund, and any applicable federal share shall be returned to the appropriate agency or department of the United States.