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Read. Follow. Verify.House Bill 216 updates penalties and expands prohibited acts under the Human Services Code for medical assistance fraud
Last action · January 22, 2025: Referred to JUDICIARY, Jan. 22, 2025Sponsors: Thomas Kutz and 5 others
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What This Bill Would Do
Pennsylvania House Bill 216 expands the list of prohibited acts, refines criminal penalties based on the dollar amount of excess payments, and mandates a five-year program ban for individuals convicted of medical assistance fraud. The legislation takes effect in 60 days.
Healthcare providers and individuals billing the medical assistance program face revised criminal charges ranging from first-degree misdemeanors to second-degree felonies depending on fraudulent claim amounts, alongside mandatory repayment and treble damages.
- House Bill 216 amends the Pennsylvania Human Services Code originally enacted in June 1967. context
- The bill was introduced in the Pennsylvania House of Representatives on January 22, 2025, and referred to the Judiciary Committee. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Medical assistance program providers
Providers face updated prohibited acts, tiered felony or misdemeanor charges based on excess payment amounts, mandatory program exclusion for five years upon conviction, and financial restitution requirements.
Office of Attorney General
The Medicaid Fraud Control Unit receives mandatory notices regarding departmental actions and suspected fraud cases under the updated statutory framework.
Key Facts
You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.
Frequently Asked Questions
What happens if a person submits a claim while excluded from the medical assistance program?
How long is a convicted provider barred from the medical assistance program?
Who has the authority to bring criminal proceedings under this legislation?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
1 action- Jan 22, 2025HouseCommitteeReferred to JUDICIARY, Jan. 22, 2025
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
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Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Restructuring of Fraud Penalty Tiers
The bill replaces a single third-degree felony rule for most violations with a tiered penalty structure based on monetary thresholds ($2,000 and $100,000) and prior convictions.
Connected Entities
Sources
www.palegis.us
Analysis Score
0–100- Significance75How much this matters to a regular citizen
- Controversy40Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz25Current news / social attention level
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