As used in this chapter, unless the context otherwise requires:
1. "Benefit" means the provision of anything of pecuniary value under the Medicaid
program.
2. "Claim" means:
a. Any request or demand, whether under a contract or otherwise, for money or
property under the Medicaid program regardless of whether the state has title to
the money or property which is:
(1)Presented to an officer, employee, or agent of the state; or
(2)Made to a contractor, grantee, or other recipient, if the money or property is
to be spent or used on the state's behalf or to advance a state program or
interest, and if the state:
(a)Provides or has provided any portion of the money or property
requested or demanded; or
(b)Will reimburse such contractor, grantee, or other recipient for any
portion of the money
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As used in this chapter, unless the context otherwise requires:
1. "Benefit" means the provision of anything of pecuniary value under the Medicaid
program.
2. "Claim" means:
a. Any request or demand, whether under a contract or otherwise, for money or
property under the Medicaid program regardless of whether the state has title to
the money or property which is:
(1) Presented to an officer, employee, or agent of the state; or
(2) Made to a contractor, grantee, or other recipient, if the money or property is
to be spent or used on the state's behalf or to advance a state program or
interest, and if the state:
(a) Provides or has provided any portion of the money or property
requested or demanded; or
(b) Will reimburse such contractor, grantee, or other recipient for any
portion of the money or property that is requested or demanded.
b. A claim does not include requests or demands for money or property the state
has paid to an individual as compensation for state employment or as an income
subsidy with no restrictions on that individual's use of the money or property.
3. "Department" means the department of health and human services.
4. "Document" means an application, claim, form, report, record, writing, or
correspondence, whether in written, electronic, magnetic, or other form.
5. "Fraud" means any conduct or activity prohibited by law or rule involving knowing
conduct or omission to perform a duty that results in or may result in payments to
which the person is not entitled.
6. "Knowingly" means "knowingly" as defined in section 12.1-02-02.
7. "Material" means having a natural tendency to influence, or be capable of influencing,
the payment or receipt of money or property.
8. "Medicaid agency" means an agency or entity of state, county, or local government
which administers any part of the Medicaid program, whether under direct statutory
authority or under contract with an authorized agency of the state or federal
government.
9. "Misappropriation of patient property" means exploitation, deliberate misplacement, or
wrongful use or taking of a patient's property, whether temporary or permanent,
without authorization by the patient or the patient's designated representative. The
term includes conduct with respect to a patient's property, which would constitute a
criminal offense under chapter 12.1-23.
10. "Obligation" means an established duty, whether fixed, arising from an express or
implied contractual, grantor-grantee, or licensor-licensee relationship, from a
fee-based or similar relationship, from statute or regulation, or from the retention of
any overpayment.
11. "Patient abuse" means the willful infliction of physical or mental injury of a patient or
unreasonable confinement, intimidation, or punishment that results in pain, physical or
mental harm, or mental anguish of a patient. The term includes conduct with respect to
a patient which would constitute a criminal offense under chapter 12.1-16, 12.1-17,
12.1-18, 12.1-20, or 12.1-22.
12. "Patient neglect" means a failure, through inattentiveness, carelessness, or other
omission, to provide to a patient goods and services necessary to avoid physical harm,
mental anguish, or mental illness if an omission is not caused by factors beyond the
person's control or by good-faith errors in judgment. The term includes conduct with
respect to a patient which would constitute a criminal offense under section
12.1-17-03.
13. "Provider" means a person that furnishes items or services for which payment is
claimed under the Medicaid program.
14. "Record" means medical, professional, business, or financial information and
documents, whether in written, electronic, magnetic, microfilm, or other form:
a. Pertaining to the provision of treatment, care, services, or items to a recipient;
b. Pertaining to the income and expenses of the provider; or
c. Otherwise relating to or pertaining to a determination of entitlement to payment or
reimbursement under the Medicaid program.