HLS 10RS-4121 ORIGINAL
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2010
HOUSE BILL NO. 1483 (Substitute for House Bill No. 1360 by Representative
Wooton)
BY REPRESENTATIVE WOOTON
FRAUD: Establishes penalties for knowingly and willfully committing health care fraud
AN ACT1
To amend and reenact R.S. 22:1924(A)(1) and to enact R.S. 22:1924(A)(3), relative to2
insurance fraud; to provide definitions; to establish penalties for knowingly and3
willfully committing health care fraud; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1924(A)(1) is hereby amended and reenacted and R.S.6
22:1924(A)(3) is hereby enacted to read as follows: 7
ยง1924. Prohibited activities and sanctions8
A.(1) Any person who, with the intent to injure, defraud, or deceive any9
insurance company, or the Department of Insurance, or any insured or other party in10
interest, or any third-party claimant commits any of the acts specified in Paragraph11
(2) or (3) of this Subsection is guilty of a felony and shall be subjected to a term of12
imprisonment, with or without hard labor, not to exceed five years, or a fine not to13
exceed five thousand dollars, or both, on each count and payment of restitution to the14
victim company of any insurance payments to the defendant that the court15
determines was not owed and the costs incurred by the victim company associated16
with the evaluation and defense of the fraudulent claim, including but not limited to17
the investigative costs, attorney fees, and court costs. However, if the benefit18
pursued does not exceed one thousand dollars, the term of imprisonment shall not19 HLS 10RS-4121 ORIGINAL
HB NO. 1483
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
exceed six months, or the fine shall not exceed one thousand dollars, or both, on each1
count.2
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(3)(a) Knowingly and willfully committing health care fraud shall be4
punishable as provided in Paragraph (1) of this Subsection.5
(b) Health care fraud shall mean, in conjunction with the delivery of or6
payment for health care benefits, items, or services:7
(i) To execute a scheme or artifice to defraud any health care benefit8
program.9
(ii) To obtain, by means of fraudulent claims, or false or fraudulent10
pretenses, representations, or promises, any of the money or property owned by, or11
under the custody or control of, any health care benefit program.12
(c) For the purposes of this Paragraph, "knowingly and willfully" shall mean13
to continue with a practice, after written notice to cease such practice from a health14
care benefit program by certified mail, return receipt requested, except when the15
health care provider reasonably believes that such practice materially complies with16
coding or billing standards as issued by the American Medical Association, the17
United States Department of Health and Human Services, the Centers for Medicare18
and Medicaid Services, or the Louisiana Medicaid Program.19
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DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Wooton HB No. 1483
Abstract: Provides penalties for knowingly and willfully committing health care fraud.
Present law provides that any person who, with the intent to injure, defraud, or deceive any
insurance company, or the Department of Insurance, or any insured or other party in interest,
or any third-party claimant commits any of the acts specified in present law is guilty of a
felony and shall be subjected to a term of imprisonment, with or without hard labor, not to
exceed 5 years, or a fine not to exceed $5000, or both, on each count and payment of
restitution to the victim company of any insurance payments to the defendant that the court
determines was not owed and the costs incurred by the victim company associated with the HLS 10RS-4121 ORIGINAL
HB NO. 1483
Page 3 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
evaluation and defense of the fraudulent claim, including but not limited to the investigative
costs, attorney fees, and court costs. However, if the benefit pursued does not exceed $1000,
the term of imprisonment shall not exceed 6 months, or the fine shall not exceed $1000, or
both, on each count.
Proposed law provides that knowingly and willfully committing health care fraud shall be
punishable as provided in present law. Defines health care fraud as doing any of the
following while in conjunction with the delivery of or payment for health care benefits,
items, or services:
(1) To execute a scheme or artifice to defraud any health care benefit program.
(2) To obtain, by means of fraudulent claims, or false or fraudulent pretenses,
representations, or promises, any of the money or property owned by, or under the
custody or control of, any health care benefit program.
Proposed law also defines "knowingly and willfully"as continuing with a practice, after
written notice to cease such practice from a health care benefit program by certified mail,
return receipt requested, except when the health care provider reasonably believes that such
practice materially complies with coding or billing standards as issued by the American
Medical Association, the United States Department of Health and Human Services, the
Centers for Medicare and Medicaid Services, or the Louisiana Medicaid Program.
(Amends R.S. 22:1924(A)(1); Adds R.S. 22:1924(A)(3))