As used in this part 8, unless the context otherwise
requires:
(1)Abuse means willful infliction of injury, unreasonable confinement,
intimidation, or punishment with resulting physical or financial harm or pain or
mental anguish, including any acts or omissions that constitute a criminal violation
under state law.
(2)Beneficiary means any individual who receives goods or services from a
provider under the medicaid program.
(3)Benefit means any benefit authorized under the Colorado Medical
Assistance Act.
(4)Claim means any communication submitted to the medicaid program or
to a person that has contracted with the medicaid program, whether oral, written,
electronic, or magnetic, that identifies a good, item, or service as reimbursable
under the medicaid program; is used to
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As used in this part 8, unless the context otherwise
requires:
(1) Abuse means willful infliction of injury, unreasonable confinement,
intimidation, or punishment with resulting physical or financial harm or pain or
mental anguish, including any acts or omissions that constitute a criminal violation
under state law.
(2) Beneficiary means any individual who receives goods or services from a
provider under the medicaid program.
(3) Benefit means any benefit authorized under the Colorado Medical
Assistance Act.
(4) Claim means any communication submitted to the medicaid program or
to a person that has contracted with the medicaid program, whether oral, written,
electronic, or magnetic, that identifies a good, item, or service as reimbursable
under the medicaid program; is used to authorize the provision of services under the
medicaid program; serves as an invoice for services provided under contract with
the medicaid program; or states income or expense and is or may be used to
determine a rate of payment under the medicaid program.
(5) Colorado Medical Assistance Act means articles 4 to 6 of title 25.5.
(6) Exploitation means the wrongful taking or use of funds or property of a
patient residing in a health-care facility or board and care facility that constitutes a
criminal violation under state law.
(7) Knowingly and willfully have the same meaning as set forth in section
18-1-501 (6).
(8) Material information means an assertion or information directly
pertaining to a claim, record, statement, or representation that a reasonable person
knows or should know will affect the action, conduct, or decision of the person who
receives or is intended to receive the asserted information in a manner that would
directly or indirectly benefit the person making the assertion.
(9) Medicaid fraud and waste means any act, by commission or omission, as
described in section 24-31-808.
(10) Medicaid program means the medical assistance program authorized
by Title XIX of the federal Social Security Act and implemented by the Colorado
Medical Assistance Act.
(11) Neglect means willful failure to provide goods and services necessary
to avoid physical harm, mental anguish, or mental illness, including any neglect that
constitutes a criminal violation under state law.
(12) Person means an individual, public or private institution, corporation,
partnership, association, or managed care entity.
(13) Provider means any person, employee, agent, representative,
contractor, or subcontractor of a person:
(a) Who has entered into a provider agreement with the department of health
care policy and financing to provide goods or services pursuant to the medicaid
program;
(b) Who has entered into an agreement with a party to such a provider
agreement under which the person agrees to provide goods or services that are
reimbursable under the medicaid program;
(c) Who is reimbursed or receives compensation for delivering, purporting to
deliver, or arranging for the delivery of health-care goods or services from the
medicaid program;
(d) Who is defined as such in section 25.5-4-103 (19); or
(e) Who is defined as such in section 25.5-4-416 (1).
(14) Records means any medical, professional, or business records relating
to the treatment or care of any beneficiary, to goods or services provided to any
beneficiary, or to rates paid for goods or services provided to any beneficiary and
any records that are required to be kept by the rules of the medicaid program.
(15) Statement or representation means any oral, written, or electronic
communication that is used to identify an item of goods or a service for which
reimbursement may be made under the medicaid program or that states income
and expense and is or may be used to determine a rate of reimbursement under the
medicaid program, that may serve as the basis for the calculation of a payment to a
provider, or that may serve as a basis for receiving payment.
(16) Unit means the medicaid fraud control unit created in section 24-31-802.