Ohio § 4121.444

§ 4121.444.

(A) No person, health care provider, managed care organization, or owner of a health

care provider or managed care organization shall obtain or attempt to obtain payments

by deception under Chapter 4121., 4123., 4127., or 4131. of the Revised Code to which

the person, health care provider, managed care organization, or owner is not entitled

under rules of the bureau of workers' compensation adopted pursuant to sections 4121.441 and 4121.442 of the Revised Code . (B) Any person, health care provider, managed care organization, or owner that violates

division (A) of this section is liable, in addition to any other penalties provided

by law, for all of the following penalties: (1) Payment of interest on the amount of the excess payments at the maximum interest

rate allowable for real estate mortgages under section 1343.01 of the Revised Code .  The interest shall be calculated from the date the payment was made to the person,

owner, health care provider, or managed care organization through the date upon which

repayment is made to the bureau or the self-insuring employer. (2) Payment of an amount equal to three times the amount of any excess payments; (3) Payment of a sum of not less than five thousand dollars and not more than ten thousand

dollars for each act of deception; (4) All reasonable and necessary expenses that the court determines have been incurred

by the bureau or the self-insuring employer in the enforcement of this section. All moneys collected by the bureau pursuant to this section shall be deposited into

the state insurance fund created in section 4123.30 of the Revised Code .  All moneys collected by a self-insuring employer pursuant to this section shall

be awarded to the self-insuring employer. (C)(1) In addition to the monetary penalties provided in division (B) of this section and

except as provided in division (C)(3) of this section, the administrator may terminate

any agreement between the bureau and a person or a health care provider or managed

care organization or its owner and cease reimbursement to that person, provider, organization,

or owner for services rendered if any of the following apply: (a) The person, health care provider, managed care organization, or its owner, or an

officer, authorized agent, associate, manager, or employee of a person, provider,

or organization is convicted of or pleads guilty to a violation of sections 2913.48 or 2923.31 to 2923.36 of the Revised Code or any other criminal offense related to the delivery of or billing for health care

benefits. (b) There exists an entry of judgment against the person, health care provider, managed

care organization, or its owner, or an officer, authorized agent, associate, manager,

or employee of a person, provider, or organization and proof of the specific intent

of the person, health care provider, managed care organization, or owner to defraud,

in a civil action brought pursuant to this section. (c) There exists an entry of judgment against the person, health care provider, managed

care organization, or its owner, or an officer, authorized agent, associate, manager,

or employee of a person, provider, or organization in a civil action brought pursuant

to sections 2923.31 to 2923.36 of the Revised Code . (2) No person, health care provider, or managed care organization that has had its agreement

with and reimbursement from the bureau terminated by the administrator pursuant to

division (C)(1) of this section, or an owner, officer, authorized agent, associate,

manager, or employee of that person, health care provider, or managed care organization

shall do either of the following: (a) Directly provide services to any other bureau provider or have an ownership interest

in a provider of services that furnishes services to any other bureau provider; (b) Arrange for, render, or order services for claimants during the period that the agreement

of the person, health care provider, managed care organization, or its owner is terminated

as described in division (C)(1) of this section; (3) The administrator shall not terminate the agreement or reimbursement if the person,

health care provider, managed care organization, or owner demonstrates that the person,

provider, organization, or owner did not directly or indirectly sanction the action

of the authorized agent, associate, manager, or employee that resulted in the conviction,

plea of guilty, or entry of judgment as described in division (C)(1) of this section. (4) Nothing in division (C) of this section prohibits an owner, officer, authorized agent,

associate, manager, or employee of a person, health care provider, or managed care

organization from entering into an agreement with the bureau if the provider, organization,

owner, officer, authorized agent, associate, manager, or employee demonstrates absence

of knowledge of the action of the person, health care provider, or managed care organization

with which that individual or organization was formerly associated that resulted in

a conviction, plea of guilty, or entry of judgment as described in division (C)(1)

of this section. (D) The attorney general may bring an action on behalf of the state and a self-insuring

employer may bring an action on its own behalf to enforce this section in any court

of competent jurisdiction.  The attorney general may settle or compromise any action brought under this section

with the approval of the administrator. Notwithstanding any other law providing a shorter period of limitations, the attorney

general or a self-insuring employer may bring an action to enforce this section at

any time within six years after the conduct in violation of this section terminates. (E) The availability of remedies under this section and sections 2913.48 and 2923.31 to 2923.36 of the Revised Code for recovering benefits paid on behalf of claimants for medical assistance does not

limit the authority of the bureau or a self-insuring employer to recover excess payments

made to an owner, health care provider, managed care organization, or person under

state and federal law. (F) As used in this section: (1) “ Deception ” means acting with actual knowledge in order to deceive another or cause another

to be deceived by means of any of the following: (a) A false or misleading representation; (b) The withholding of information; (c) The preventing of another from acquiring information; (d) Any other conduct, act, or omission that creates, confirms, or perpetuates a false

impression as to a fact, the law, the value of something, or a person's state of mind. (2) “ Owner ” means any person having at least a five per cent ownership interest in a health

care provider or managed care organization.