Colorado § 25.5-4-305 - False medicaid claims - liability for certain acts - false medicaid claims recovery fund.

§ 25.5-4-305. False medicaid claims - liability for certain acts - false medicaid claims recovery fund.

(1) Except as otherwise provided in subsection (2) of this section, a person is liable to the state for a civil penalty of not less than five thousand five hundred dollars and not more than eleven thousand dollars; except that these upper and lower limits on liability shall automatically increase to equal the civil penalty allowed under the federal "False Claims Act", 31 U.S.C. sec. 3729, et seq., if and as the penalties in such federal act may be adjusted for inflation as described in said act in accordance with the federal "Civil Penalties Inflation Adjustment Act of 1990", Pub. L. No. 101-410, plus three times the amount of damages that the state sustains because of the act of that person, if the person:

(a) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;

(b) Knowingly makes, uses, or causes to be made or used a false record or statement material to a false or fraudulent claim;

(c) Has possession, custody, or control of property or money used, or to be used, by the state in connection with the "Colorado Medical Assistance Act"and knowingly delivers, or causes to be delivered, less than all of the money or property;

(d) Authorizes the making or delivery of a document certifying receipt of property used, or to be used, by the state in connection with the "Colorado Medical Assistance Act" and, intending to defraud the state, makes or delivers the receipt without completely knowing that the information on the receipt is true;

(e) Knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the state in connection with the "Colorado Medical Assistance Act" who lawfully may not sell or pledge the property;

(f) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the state in connection with the "Colorado Medical Assistance Act", or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the state in connection with the "Colorado Medical Assistance Act";

(g) Conspires to commit a violation of paragraphs (a) to (f) of this subsection (1).

(2) Notwithstanding the amount of damages authorized in subsection (1) of this section, for a person who violates subsection (1) of this section, the court may assess not less than twice the amount of damages that the state sustains because of the act of the person if the court finds that:

(a) The person who committed the violation of subsection (1) of this section furnished to the officials of the state responsible for investigating false claims violations all information about the violation known to the person and furnished said information within thirty days after the date on which the person first obtained the information;

(b) At the time the person furnished the information about the violation to the state, a criminal prosecution, civil action, or administrative action had not commenced with respect to the violation and the person did not have actual knowledge of the existence of an investigation into the violation; and

(c) The person fully cooperated with any investigation of the violation by the state.

(3) (a) In addition to any other liability, a person violating this section is liable to the federal government, state government, and affected agencies and political subdivisions thereof, including the department of law, for full reasonable expenses incurred in a civil action brought to recover penalties or remedies under the "Colorado Medicaid False Claims Act", sections 25.5-4-303.5 to 25.5-4-310, including the costs of investigation and litigation, attorney fees, court costs, witness fees, and deposition costs. Recovered costs and fees shall be transferred to the state treasurer for deposit in the false medicaid claims recovery fund, which fund is created in subsection (3)(b) of this section.

(b) (I) The false medicaid claims recovery fund is created in the state treasury. The fund consists of money credited to the fund pursuant to subsection (3)(a) of this section and any other money that the general assembly may appropriate or transfer to the fund.

(II) The state treasurer shall credit all interest and income derived from the deposit and investment of money in the false medicaid claims recovery fund to the fund.

(III) Any money remaining in the fund at the end of a state fiscal year remains in the fund.

(IV) Subject to annual appropriation by the general assembly, the attorney general may expend money from the fund for the purpose of hiring necessary staff to implement the medicaid fraud control unit in the department of law and to defray the costs of investigating and litigating ongoing false claims cases by the unit.

(c) Proceeds recovered as a result of an action filed pursuant to the "Colorado Medicaid False Claims Act", sections 25.5-4-303.5 to 25.5-4-310, shall be distributed in the following order:

(I) To refund money falsely obtained from the federal government or state government or a political subdivision thereof; and

(II) To the state treasurer for deposit in the general fund, except as described in subsection (3)(e) of this section.

(d) A portion of the recovery equal to the amount of money falsely obtained from the federal government, the state government, an affected political subdivision thereof, or state agencies, or a combination thereof, shall be remitted to the entity shown to be defrauded, subject to any further requirements established by federal or state law.

(e) Upon receipt of a distribution described in subsection (3)(c)(II) of this section, the state treasurer shall deposit the entire amount in the general fund; except that, subject to relevant guidelines of the federal department of health and human services' office of inspector general regarding repayment of fees or recoveries, the state treasurer shall credit twenty percent of such a distribution to the false medicaid claims recovery fund created in subsection (3)(b) of this section.

(4) Any information furnished pursuant to subsection (2) of this section shall be exempt from disclosure under part 2 of article 72 of this title.

Source: L. 2006: Entire article added with relocations, p. 1839, § 7, effective July 1. L. 2010: Entire section R&RE, (SB 10-167), ch. 296, p. 1380, § 12, effective May 26. L. 2011: IP(1) amended, (HB 11-1303), ch. 264, p. 1168, § 66, effective August 10. L. 2013: IP(1) and (1)(a) amended, (SB 13-205), ch. 276, p. 1441, § 4, effective August 7. L. 2026: (3) amended, (HB 26-1426), ch. 334, p. 2027, § 103, effective August 12.

Editor's note: This section is similar to former § 26-4-1103 (1) and (2) as they existed prior to 2006.

Cross references: For the legislative declaration in SB 10-167, see section 1 of chapter 296, Session Laws of Colorado 2010.

ANNOTATION

Law reviews. For article, "Colorado's Medicaid Compliance Statutes: False Statements and Claims, Kickbacks, and Physician Referrals", see 36 Colo. Law. 31 (Mar. 2007).