Kentucky Revised Statutes

Ky. Rev. Stat. § 205.8463 (2026)

Fraudulent acts -- Penalties

✓ current as of May 2026

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(1) No person shall knowingly or wantonly devise a scheme or plan a scheme or artifice, or enter into an agreement, combination, or conspiracy to obtain or aid another in obtaining payments from any medical assistance program under this chapter by means of any fictitious, false, or fraudulent application, claim, report, or document submitted to the Cabinet for Health and Family Services, or intentionally engage in conduct which advances the scheme or artifice.

(2) No person shall intentionally, knowingly, or wantonly make, present, or cause to be made or presented to an employee or officer of the Cabinet for Health and Family Services any false, fictitious, or fraudulent statement, representation, or entry in any application, claim, report, or document used in determining rights to any benefit or payment.

(3) No person shall, with intent to defraud, knowingly make, or induce, or seek to induce the making of a false statement or false representation of a material fact with respect to the conditions or operations of an institution or facility in order that the institution or facility may qualify, upon initial certification or upon recertification, as a hospital, skilled-nursing facility, intermediate-care facility, home-health agency, or other provider of services to the Medical Assistance Program.

(4) No person shall, in any matter within the jurisdiction of the Cabinet for Health and Family Services under this chapter, knowingly falsify, conceal, or cover up by any trick, scheme, or device a material fact, or make any false, fictitious, or fraudulent statement or representation, or make or use any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry.

(5) (a) Any person who violates subsections (1) and (2) of this section shall be guilty of a Class B misdemeanor unless:

1. The sum total of benefits or payments claimed in any application, claim, report, or document, or in any combination or aggregation thereof, is valued at five hundred dollars ($500) or more but less than one thousand dollars ($1,000), in which case it is a Class A misdemeanor;

2. The sum total of benefits or payments claimed in any application, claim, report, or document, or in any combination or aggregation thereof, is valued at or above one thousand dollars ($1,000), in which case it is a Class D felony; or

3. The person has three (3) or more convictions under subparagraph 1. of this paragraph within the last five (5) years, in which case it is a Class D felony. The five (5) year period shall be measured from the dates on which the offenses occurred for which the judgments of conviction were entered.

(b) If any person commits two (2) or more separate violations of subsections (1) and (2) of this section within ninety (90) days, the offenses may be combined and treated as a single offense, and the value of the property in each offense may be aggregated for the purpose of determining the appropriate charge.

(6) Any person who violates the provisions of subsection (3) of this section shall be guilty of a Class C felony.

(7) Any person who violates the provisions of subsection (4) of this section shall be guilty of a Class D felony. Effective: June 29, 2021 History: Amended 2021 Ky. Acts ch. 66, sec. 2, effective June 29, 2021. -- Amended 2005 Ky. Acts ch. 99, sec. 279, effective June 20, 2005. -- Amended 1998 Ky. Acts ch. 426, sec. 226, effective July 15, 1998. -- Created 1994 Ky. Acts ch. 96, sec. 7, effective July 15, 1994; and ch. 316, sec. 7, effective July 15, 1994.

Notes of Decisions

Cited in 9 cases (6 in the last 5 years), 2012–2026 · leading case: Commonwealth v. Grider, 390 S.W.3d 803 (Ky. Ct. App. 2012).

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Commonwealth v. Grider, 390 S.W.3d 803 (Ky. Ct. App. 2012). “” The letter continued, explaining that “Eric Grider ha[d] been indicted by the Franklin County Grand Jury for engaging in a scheme to defraud [the Medicaid Program] by billing Medicaid for one prescription, while dispensing another in violation of KRS 205.8463.” Therefore, the…”

Sandoz Inc. v. Commonwealth ex rel. Conway, 405 S.W.3d 506 (Ky. Ct. App. 2012). “Following a jury trial, San-doz was found liable to the Commonwealth under the Kentucky Medicaid Fraud Statute, KRS 205.8463(4), the Kentucky False Advertising Statute, KRS 517.”

Elfers v. Allen (E.D. Ky. 2025). · cites it 14× “8463 does not provide a private right of action.”

Matt Anderson; USA & Commonwealth of Kentucky, ex rel v. Saint Elizabeth Med. Ctr., INC. (E.D. Ky. 2025). · cites it 8× “Count II: Medicaid Fraud under KRS § 205.8463 Count II fails as a matter of law because Anderson does not state a cognizable legal claim.”

Akande v. Commonwealth, 565 S.W.3d 167 (Ky. Ct. App. 2018). · cites it 5× “030, theft by unlawful taking of property; and KRS 205.8463, Medical Assistance Program fraud.”

United States v. Saint Elizabeth Med. Ctr., Inc. (E.D. Ky. 2025). · cites it 3× “FACTUAL AND PROCEDURAL HISTORY Relator filed this qui tam action under the False Claims Act (“FCA”) and the Kentucky Medicare False Claims Statute, Ky. Rev. Stat. § 205.8463, on September 13, 2023, against Defendants.”

Marcus S. Minix, Sr. v. Commonwealth of Kentucky (Ky. Ct. App. 2026). · cites it 2× “030 and KRS 205.8463. The first statute, KRS 514.”

Est. of Evelyn Sue Tate v. Commonwealth of Kentucky, Cabinet for Health & Fam. Servs., Dep't for Medicaid Servs. (Ky. Ct. App. 2023). “KRS 205.8463 states, (1) No person shall knowingly or wantonly devise a scheme or plan a scheme or artifice, or enter into an agreement, combination, or conspiracy to obtain or aid another in obtaining payments from any medical assistance program under this chapter by means of…”

U.S. ex rel. Matt Anderson v. St. Elizabeth Med. Ctr. (6th Cir. 2026). “And he pleaded his state-law claim under what he called the “Kentucky Medicare False Claims Statute,” codified at Ky. Rev. Stat. § 205.8463—a provision of the state’s criminal code.”

— Ky. Rev. Stat. § 205.8463(1) — 1 case

Marcus S. Minix, Sr. v. Commonwealth of Kentucky (Ky. Ct. App. 2026). “030 and KRS 205.8463. The first statute, KRS 514.”

— Ky. Rev. Stat. § 205.8463(2) — 1 case

Akande v. Commonwealth, 565 S.W.3d 167 (Ky. Ct. App. 2018). “030, theft by unlawful taking of property; and KRS 205.8463, Medical Assistance Program fraud.”

— Ky. Rev. Stat. § 205.8463(4) — 1 case

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