218 R.I. Code R. 218-RICR-40-00-2.4

Current through December 3, 2024
Section 218-RICR-40-00-2.4 - Fraud and Abuse
2.4.1Fraud and Abuse
A. The Division shall declare ineligible any consumer who abuses or misuses RIPAE. The Division is empowered to investigate cases of suspected provider or consumer fraud.
B. Delegate agencies and participating pharmacies shall report to the Division any suspected incident of fraud or abuse. Such reports shall be made to the Director or designee.
C. Fraud and abuse shall include but not be limited to:
1. Falsification of information on the application for assistance;
2. Use or attempted use of an eligibility card by an unauthorized individual;
3. Falsification of information by a participating pharmacy;
4. Consumer or provider claims for duplicative benefits;
5. Any violation or attempt to violate the provisions of R.I. Gen. Laws Chapter 42-66.2, as amended or this Part.
D. Individuals attempting fraud or abuse and individuals who aid or abet another in attempting fraud or abuse shall be subject to R.I. Gen. Laws § 42-66.2-8, as amended.
E. Any provider or consumer found guilty of intentionally violating the provisions of these rules and regulations shall be subject to R.I. Gen. Laws § 42-66.2-8, as amended.
F. Any provider or consumer who is found guilty under the Act and these regulations shall be subject to R.I. Gen. Laws § 42-66.2-8, as amended.

218 R.I. Code R. 218-RICR-40-00-2.4