ARSD 67:48:01:05. Medical benefit paid in error as result of intentional program violation

A medical benefit paid in error includes a payment made as a result of an intentional program violation. An intentional program violation exists if an administrative hearing or a court of appropriate jurisdiction finds that the individual or the individual's authorized representative intentionally made a false or misleading statement or misrepresented, concealed, or withheld facts or intentionally acted to mislead, misrepresent, conceal withhold facts, or propound a falsity for the purpose of establishing or maintaining eligibility under article 67:46 or increasing or preventing a reduction in the amount of medical benefits payable on behalf of the individual. The individual or the individual's authorized representative may sign a waiver waiving the individual's rights to an administrative hearing.