False Health Care Claims Prohibited

(1) The Board may take disciplinary action against a registered chiropractor, or a chiropractic facility pursuant to 233 CMR 4.06, if the registered chiropractor or any agent, servant or employee of the registered chiropractor or of the chiropractic facility makes any false statement or misrepresentation of material fact in connection with any application or claim for payment of any health care benefit. (2) For purposes of 233 CMR 4.06 and 4.11, “making a false statement or misrepresentation of material fact in connection with any application or claim for payment of any health care benefit” includes, but is not limited to, any of the following: (a) Making or causing to be made any false statement or misrepresentation of a material fact in any application for payment of a health care benefit; (b) Presenting, or causing the presentation of, any application for a health care benefit which contains any false statement or misrepresentation of a material fact; (c) Making, or causing the making of, any false statement or misrepresentation of a material fact for use in determining a patient’s entitlement to any health care benefit, including whether particular goods or services were medically necessary in accordance with accepted standards of Chiropractic practice; or (d) Concealing, or failing to disclose, the occurrence of an event which affects a patient’s initial or continued right to any health care benefit for the purpose of enabling the patient to fraudulently secure that health care benefit either in a greater amount than is due or when no such benefit is due. (3) A statement made in connection with an application or claim for payment of a health care benefit is false, within the meaning of 233 CMR 4.11, if it is wholly or partially false, fictitious, fraudulent, untrue or deceptive.