MISUTILIZATION AND ABUSE OF PROGRAM BENEFITS
§ 22.71. False or fraudulent claims by applicants and claimants.
Applicants, claimants or other persons submit a false or fraudulent claim subject to administrative action and penalties of § 22.73 (relating to administrative actions and penalties) if they commit one or more of the following acts:
(1) Make or cause to be made a false statement or representation of a material fact in any application for any benefit.
(2) Attempt to secure for personal use or the use of another individual an unauthorized benefit by concealing or failing to disclose known information which would result in the rejection of an application for initial or continued eligibility for the benefit.
(3) Having made application to receive a benefit for personal use or the use of another and having received it, convert the benefit or a part thereof to a use other than that for which it was intended.
(4) Seek to obtain from providers excessive services or benefits beyond what is reasonably needed, as determined by the Department, for the treatment of a diagnosed condition of the claimant.
(5) Borrow or use a PACE identification card to which the person is not entitled or otherwise gain or attempt to gain benefits under the PACE Program if the person has not been determined eligibile for the program and enrolled in it.
Source The provisions of this § 22.71 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103137).
Cross References This section cited in 6 Pa. Code § 22.73 (relating to administrative actions and penalties).
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