False billing practices of health care provider, defined, effect
This law is about health care providers who lie on workers' compensation insurance claims. Four types of lying are covered: billing for separate procedures when only one was done, claiming a bigger or more serious procedure than what actually happened, claiming many tests were run when it was really just one group of tests, and sending the same bill twice through different providers that are connected. A government department can investigate people suspected of doing these things, including gathering evidence and calling witnesses. Someone who breaks this law the first time can be charged with a misdemeanor and fined up to $20,000. Someone who breaks it again after already being found guilty can be charged with a felony.
Classifications stated in the statute. Actual outcomes vary.
287.129. False billing practices of , defined, effect — of commerce and insurance, powers — . — 1. A health care provider commits a if he or she and with presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an , purported insurer, broker, or any thereof, any for payment or other which involves any one or more of the following false billing practices:
(1) "" an insurance claim by claiming a number of medical procedures were performed instead of a single comprehensive procedure;
(2) "" a medical, hospital or rehabilitative insurance claim by claiming that a more serious or extensive procedure was performed than was actually performed;
(3) "" a medical, hospital or rehabilitative insurance claim by claiming a series of tests were performed on a single sample of blood, urine, or other bodily fluid, when actually the series of tests were part of one of tests; or
(4) "" a medical, hospital or rehabilitative insurance claim made by a health care provider by resubmitting the claim through another health care provider in which the original health care provider has an ownership interest.
2. If, by its own inquiries or as a result of complaints, the department of commerce and insurance has reason to believe that a person has engaged in, or is engaging in, any fraudulent workers' compensation insurance act contained in this section, it may , serve ordering the attendance of witnesses or proffering of matter, and collect evidence.
3. If the matter that the department of commerce and insurance seeks to obtain by request is located outside the state, the person so requested may make it available to the or its to examine the matter at the place where it is located. The department may representatives, including officials of the state in which the matter is located, to inspect the matter on its behalf, and it may respond to similar requests from officials of other states.
4. Any person violating any of the of 1 of this section is guilty of a and the person shall be to the state of Missouri for a fine up to twenty thousand dollars. Any person who has previously been of violating any of the provisions of subsection 1 of this section and who subsequently violates any of the provisions of subsection 1 of this section is guilty of a .
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Source & history notes
(L. 1993 S.B. 251, A.L. 2005 S.B. 1 & 130, A.L. 2014 S.B. 491) Effective 1-01-17
Legal information, not legal advice. Always confirm with the official source at revisor.mo.gov.