108A-64. Medical assistance recipient fraud.
(a) It shall be unlawful for any person to knowingly and willfully and with intent to defraud make or cause to be made a false statement or representation of a material fact in an application for assistance under this Part, or intended for use in determining entitlement to such assistance.
(b) It shall be unlawful for any applicant, recipient or person acting on behalf of such applicant or recipient to knowingly and willfully and with intent to defraud, conceal or fail to disclose any condition, fact or event affecting such applicant's or recipient's initial or continued entitlement to receive assistance under this Part.
(b1) It is unlawful for any person knowingly, willingly, and with intent to defraud, to obtain or attempt to obtain, or to assist, aid, or abet another person, either directly or indirectly, to obtain money, services, or any other thing of value to which the person is not entitled as a recipient under this Part, or otherwise to deliberately misuse a Medicaid identification card. This misuse includes the sale, alteration, or lending of the Medicaid identification card to others for services and the use of the card by someone other than the recipient to receive or attempt to receive Medicaid program coverage for services rendered to that individual.
Proof of intent to defraud does not require proof of intent to defraud any particular person.
(c) (1) A person who violates a provision of this section shall be guilty of a Class I felony if the value of the assistance wrongfully obtained is more than four hundred dollars ($400.00).
(2) A person who violates a provision of this section shall be guilty of a Class 1 misdemeanor if the value of the assistance wrongfully obtained is four hundred dollars ($400.00) or less.
(d) For purposes of this section the word "person" includes any natural person, association, consortium, corporation, body politic, partnership, or other group, entity or organization. (1981, c. 275, s. 1; 1993, c. 539, s. 817; 1994, Ex. Sess., c. 24, s. 14(c); 1995, c. 317, s. 1.)
Structure North Carolina General Statutes
North Carolina General Statutes
Chapter 108A - Social Services
Article 2 - Programs of Public Assistance.
§ 108A-25 - Creation of programs; assumption by federally recognized tribe of programs.
§ 108A-25.1A - Responsibility for errors.
§ 108A-25.2 - Exemption from limitations for individuals convicted of certain drug-related felonies.
§ 108A-25.3 - Garnishment of wages to recoup fraudulent public assistance program payment.
§ 108A-26.5 - NC FAST caseworker training and certification program.
§ 108A-27.01 - Income eligibility and payment level for Work First Family Assistance.
§ 108A-27.1 - Time limitations on assistance.
§ 108A-27.2 - General duties of the Department.
§ 108A-27.3 - Electing Counties - Duties of county boards of commissioners.
§ 108A-27.4 - Electing Counties - County Plan.
§ 108A-27.5 - Electing Counties - Duties of the Department.
§ 108A-27.7 - Standard Program County Plan.
§ 108A-27.8 - Standard Program Counties - Duties of Department.
§ 108A-27.10 - Duties of the Director of the Budget/Governor.
§ 108A-27.11 - Work First Program funding.
§ 108A-27.12 - Maintenance of effort.
§ 108A-27.13 - Performance standards.
§ 108A-27.14 - Corrective action.
§ 108A-27.15 - Assistance not an entitlement; appeals.
§ 108A-29 - Priority for employment services.
§ 108A-29.1 - Drug screening and testing for Work First Program applicants and recipients.
§ 108A-31 - Application for assistance.
§ 108A-36 - Assistance not assignable; checks payable to decedents.
§ 108A-37 - Personal representative for mismanaged public assistance.
§ 108A-38 - Protective and vendor payments.
§ 108A-39 - Fraudulent misrepresentation.
§ 108A-41 - (Effective until contingency met see note) Eligibility.
§ 108A-42 - Determination of disability.
§ 108A-43 - Application procedure.
§ 108A-44 - State funds to counties.
§ 108A-46.1 - Transfer of assets for purposes of qualifying for State-county Special Assistance.
§ 108A-47 - Limitations on payments.
§ 108A-48 - State Foster Care Benefits Program.
§ 108A-49 - Foster care and adoption assistance payments.
§ 108A-49.1 - Foster care and adoption assistance payment rates.
§ 108A-50 - State benefits for certain adoptive children.
§ 108A-50.1 - Special Needs Adoptions Incentive Fund.
§ 108A-50.2 - Adoption Promotion Fund.
§ 108A-51 - Authorization for Food and Nutrition Services.
§ 108A-51.1 - Prohibition on certain waivers.
§ 108A-52 - Determination of eligibility.
§ 108A-53 - Fraudulent misrepresentation.
§ 108A-53.1 - Illegal possession or use of electronic food and nutrition benefits.
§ 108A-54.2 - (Effective until contingency met see note) Procedures for changing medical policy.
§ 108A-54.3A - Eligibility categories and income thresholds.
§ 108A-54.4 - Income disregard for federal cost-of-living adjustments.
§ 108A-54.5 - Maintenance of waivers for dependents of members of Armed Forces.
§ 108A-55.1 - Medicare enrollment required.
§ 108A-55.3 - Verification of State residency required for medical assistance.
§ 108A-55.4 - Insurers to provide certain information to Department of Health and Human Services.
§ 108A-55.5 - Eligibility monitoring for medical assistance.
§ 108A-56 - Acceptance of federal grants.
§ 108A-57.1 - Rules governing transfer of medical assistance benefits between counties.
§ 108A-58.2 - Waiver of transfer of assets penalty due to undue hardship.
§ 108A-60 - Protection of patient property.
§ 108A-62 - Therapeutic leave for medical assistance patients.
§ 108A-63 - Medical assistance provider fraud.
§ 108A-63.1 - Health care fraud subpoena to produce documents.
§ 108A-64 - Medical assistance recipient fraud.
§ 108A-64.1 - Incentives to counties to recover fraudulent Medicaid expenditures.
§ 108A-65 - Conflict of interest.
§ 108A-66.1 - Medicaid buy-in for workers with disabilities.
§ 108A-67 - Medicare/Qualified Disabled Working Individuals.
§ 108A-68 - Drug Use Review Program; rules.
§ 108A-68.1 - Certain prescription drugs exempt from prior authorization requirements.
§ 108A-69 - Employer obligations.
§ 108A-70 - Recoupment of amounts spent on medical care.
§ 108A-70.4 - Long-Term Care Partnership Program.
§ 108A-70.5 - Medicaid Estate Recovery Plan.
§ 108A-70.9A - (Effective until contingency met see note) Definitions; Medicaid recipient appeals.
§ 108A-70.9B - (Effective until contingency met see note) Contested Medicaid cases.
§ 108A-70.9C - Informal review permitted.
§ 108A-70.12 - Liability for certain acts; damages; effect of repayment.
§ 108A-70.13 - False claims procedure.
§ 108A-70.14 - Civil investigative demand.
§ 108A-70.15 - Employee remedies.
§ 108A-70.16 - Uniformity of interpretation.
§ 108A-70.37 - Timely decision standards.
§ 108A-70.38 - Timely processing standards.
§ 108A-70.39 - Average processing time standards.
§ 108A-70.40 - Percentage processed timely standards.
§ 108A-70.41 - Corrective action.
§ 108A-70.42 - Temporary assumption of Medicaid eligibility administration.
§ 108A-70.43 - (Effective until contingency met see note) Reporting.
§ 108A-70.46 - Audit of county Medicaid determinations.
§ 108A-70.47 - Medicaid eligibility determination processing accuracy standards.
§ 108A-70.48 - Quality assurance.
§ 108A-70.49 - Corrective action.
§ 108A-70.50 - Temporary assumption of Medicaid eligibility administration.
§ 108A-70.51 - (Effective until contingency met see note) Reporting.