As used in this subchapter:
(1) (A) "Abuse" means provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.
(B) "Abuse" includes recipient practices that result in an unnecessary cost to the Medicaid program;
(2) (A) "Fraud" means a purposeful deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to the person or another person.
(B) "Fraud" includes any act that constitutes fraud under applicable federal or state law;
(3) "Health plan" means a publicly or privately funded health insurance or managed care plan or contract under which a healthcare item or service is provided and through which payment is made to the person who provided the healthcare item or service;
(4) "Investigation" means investigations of fraud, abuse, or illegal acts perpetrated within the medical assistance program by providers or recipients of medical assistance care, services, and supplies;
(5) "Person" means an individual or entity other than a recipient of a healthcare item or service;
(6) "Recovery" means any action or attempt by the Medicaid Inspector General to recoup or collect Medicaid payments already made to a provider with respect to a claim by:
(A) Reducing other payments currently owed to the provider;
(B) Withholding or setting off the amount against current or future payments to the provider;
(C) Demanding payment back from a provider for a claim already paid; or
(D) Reducing or affecting in any other manner the future claim payments to the provider;
(7) "Single health plan" includes without limitation the Arkansas Medicaid Program; and
(8) "Waste" means that taxpayers are not receiving reasonable value for money in connection with a government-funded activity due to an inappropriate act or omission involving mismanagement, inappropriate actions, and inadequate oversight by the person with control over or access to government resources.
Section: 20-77-2502 20-77-2503 20-77-2504 20-77-2505 20-77-2506 20-77-2507 20-77-2508 20-77-2509 20-77-2510 20-77-2511 20-77-2512 20-77-2513 NextLast modified: November 15, 2016