U.S. Code § 931 ~ Federal law on Misrepresentation ~ Penalty for misrepresentation
by faithgibson on May 25, 2019
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Since the federal MediCaid program reimburses doctors and hospitals for approximately 49% of all maternity care services in the US, its appropriate to mention that under Title 33 U.S. Code § 931 (Penalty for misrepresentation) anyone who “knowingly and willfully makes a false statement or representation for the purpose of obtaining a benefit or payment under this chapter shall be guilty of a felony“.
https://www.law.cornell.edu/uscode/text/33/931
33 U.S. Code § 931.Penalty for misrepresentation
(a)Felony; fine; imprisonment
(1)
Any claimant or
representative of a claimant who
knowingly and willfully makes a false statement or representation for the purpose of obtaining a benefit or payment under this chapter shall be guilty of a felony, and on conviction thereof shall be punished by a fine not to exceed $10,000, by imprisonment not to exceed five years, or by both.
(2)
The
United States attorney for the district in which the
injury is alleged to have occurred shall make every reasonable effort to promptly investigate each complaint made under this subsection.
(b)List of persons disqualified from representing claimants
(2)
(A)
The
Secretary shall annually prepare a list of those individuals in each
compensation district who have represented claimants for a fee in cases under this chapter and who are not authorized to represent claimants. The names of individuals contained on the list required under this subparagraph shall be made available to
employees and
employers in each
compensation district through posting and in such other forms as the
Secretary may prescribe.
(B)Individuals shall be included on the list of those not authorized to represent claimants under this chapter if the Secretary determines under this section, in accordance with the procedure provided in subsection (j) of section 907 of this title, that such individual—
(i)
has been convicted (without regard to pending appeal) of any crime in connection with the representation of a claimant under this chapter or any workers’
compensation statute;
(ii)
has engaged in fraud in connection with the presentation of a claim under this or any workers’
compensation statute, including, but not limited to, knowingly making false representations, concealing or attempting to conceal material facts with respect to a claim, or soliciting or otherwise procuring false testimony;
(iii)
has been prohibited from representing claimants before any other workers’
compensation agency for reasons of professional misconduct which are similar in nature to those which would be grounds for disqualification under this paragraph; or
(iv)
has accepted fees for representing claimants under this chapter which were not approved, or which were in excess of the amount approved pursuant to
section 928 of this title.
(C)
Notwithstanding subparagraph (B), no individual who is on the list required to be maintained by the
Secretary pursuant to this section shall be prohibited from presenting his or her own claim or from representing without fee, a claimant who is a spouse, mother, father,
sister, brother, or
child of such individual.
(D)
A determination under subparagraph (A) shall remain in effect for a period of not less than three years and until the
Secretary finds and gives notice to the public that there is reasonable assurance that the basis for the determination will not reoccur.
(3)
No
employee shall be liable to pay a representation fee to any
representativewhose fee has been disallowed by reason of the operation of this paragraph.
(4)
The
Secretary shall issue such rules and regulations as are necessary to carry out this section.
(c)False statements or representation to reduce, deny, or terminate benefits
A person including, but not limited to, an employer, his duly authorized agent, or anemployee of an insurance carrier who knowingly and willfully makes a false statement or representation for the purpose of reducing, denying, or terminating benefits to an injuredemployee, or his dependents pursuant to section 909 of this title if the injury results in death, shall be punished by a fine not to exceed $10,000, by imprisonment not to exceed five years, or by both.
