If, after investigation, the Department determines that a
provider has submitted or has caused to be submitted claims for payments which
the provider is not otherwise entitled to receive, the Department will, in
addition to the administrative action described in §§
1101.82-1101.84 (relating to
administrative procedures), refer the case record to the Medicaid Fraud Control
Unit of the Department of Justice for further investigation and possible
referral for prosecution under Federal, State and local laws. Providers who are
convicted by a Federal court of willfully defrauding the Medicaid program are
subject to a $25,000 fine or up to five years imprisonment or
both.
