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COMAR 10.09.24.01-.16 1728 State of Maryland Medical Assistance Manual Revised July 2012
during any period of eligibility;
(3) Lending a Medical Assistance card to another person;
(4) Using or attempting to use a Medical Assistance card with intent to secure fraudulently benefits which are not authorized.
C. LDSS Reporting. All cases of suspected Medicaid fraud that are discovered by personnel of a local department of social services shall be reported to the Division of Utilization and Eligibility Review of the Medical Care Compliance Administration on a form specified by the Division of Utilization and Eligibility Review.
D. Other Reporting. All cases of suspected Medicaid fraud that are discovered by agencies other than a local department of social services, that is, other state or federal agencies, providers, or concerned citizens, may be reported to the Division of Utilization and Eligibility Review in writing or by telephone.
E. Division of Utilization and Eligibility Review. The Division of Utilization and Eligibility Review shall review and, when appropriate, investigate all referrals when an allegation is made that a misrepresentation of a material fact has been made or is suspected to have been made.
F. Disposition of Referrals. Each referral shall be processed by the Division of Utilization and Eligibility Review for appropriate resolution which includes, but is not limited to: (1) Referral for prosecution; (2) Filing of charges at District Court;
(3) Recovery of incorrect benefit payments;
(4) A finding that the allegation has not been sustained; (5) Referral to the appropriate agency; and (6) Other administrative action.
G. Penalties. A person convicted of the crime of Medicaid fraud is subject to penalties as described in Criminal Law Article, §§8-510—8-512, Annotated Code of Maryland.
.14-1 Recipient Abuse.
A. Forms of Abuse. Recipient abuse exists when:
(1) A recipient utilizes an inappropriate type of provider for care;
(2) A recipient utilizes an appropriate type of provider at an inappropriate frequency for care; (3) A recipient utilizes an appropriate provider in an inappropriate manner; or