5045            FRAUD

The misrepresentation of fact or omission of information with the intent of illegally obtaining service, payment, or other gain constitutes fraud.  Fraud exists when a recipient intentionally fails to comply with instructions to report income, resources, household composition or other factors which may affect eligibility for Medicaid, or intentionally fails to report changes in these circumstances.

Fraud also includes circumstances when a provider of medical services knowingly and willingly bills Medicaid for services not rendered.

Persons knowingly and willingly aiding a recipient or provider in committing fraud are considered to be aiding in the commission of the act and may also be held responsible.