Terms Used In Utah Code > Title 63A > Chapter 13 > Part 5 - Reporting

• Abuse: means :
       (1)(a) an action or practice that:

            (1)(a)(i) is inconsistent with sound fiscal, business, or medical practices; and

            (1)(a)(ii) results, or may result, in unnecessary Medicaid related costs; or
       (1)(b) reckless or negligent upcoding. See Utah Code 63A-13-102
• Agency: means a board, commission, institution, department, division, officer, council, office, committee, bureau, or other administrative unit of the state, including the agency head, agency employees, or other persons acting on behalf of or under the authority of the agency head, the Legislature, the courts, or the governor, but does not mean a political subdivision of the state, or any administrative unit of a political subdivision of the state. See Utah Code 63A-1-103
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Division: means the Division of Integrated Healthcare, created in Section 26B-3-102. See Utah Code 63A-13-102
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• Fraud: means an intentional or knowing:
       (6)(a) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, a claim, reimbursement, or services; or
       (6)(b) violation of a provision of Sections 26B-3-1102 through 26B-3-1106. See Utah Code 63A-13-102
• Fraud unit: means the Medicaid Fraud Control Unit of the attorney general's office. See Utah Code 63A-13-102
• Health care professional: means a person licensed under:
       (8)(a) Title 58, Chapter 5a, Podiatric Physician Licensing Act;
       (8)(b) Title 58, Chapter 16a, Utah Optometry Practice Act;
       (8)(c) Title 58, Chapter 17b, Pharmacy Practice Act;
       (8)(d) Title 58, Chapter 24b, Physical Therapy Practice Act;
       (8)(e) Title 58, Chapter 31b, Nurse Practice Act;
       (8)(f) Title 58, Chapter 40, Recreational Therapy Practice Act;
       (8)(g) Title 58, Chapter 41, Speech-Language Pathology and Audiology Licensing Act;
       (8)(h) Title 58, Chapter 42a, Occupational Therapy Practice Act;
       (8)(i) Title 58, Chapter 44a, Nurse Midwife Practice Act;
       (8)(j) Title 58, Chapter 49, Dietitian Certification Act;
       (8)(k) Title 58, Chapter 60, Mental Health Professional Practice Act;
       (8)(l) Title 58, Chapter 67, Utah Medical Practice Act;
       (8)(m) Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
       (8)(n) Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act;
       (8)(o) Title 58, Chapter 70a, Utah Physician Assistant Act; and
       (8)(p) Title 58, Chapter 73, Chiropractic Physician Practice Act. See Utah Code 63A-13-102
• Inspector general: means the inspector general of the office, appointed under Section 63A-13-201. See Utah Code 63A-13-102
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Office: means the Office of Inspector General of Medicaid Services, created in Section 63A-13-201. See Utah Code 63A-13-102
• Person: means :
       (24)(a) an individual;
       (24)(b) an association;
       (24)(c) an institution;
       (24)(d) a corporation;
       (24)(e) a company;
       (24)(f) a trust;
       (24)(g) a limited liability company;
       (24)(h) a partnership;
       (24)(i) a political subdivision;
       (24)(j) a government office, department, division, bureau, or other body of government; and
       (24)(k) any other organization or entity. See Utah Code 68-3-12.5
• Provider: means a person that provides:
       (11)(a) medical assistance, including supplies or services, in exchange, directly or indirectly, for Medicaid funds; or
       (11)(b) billing or recordkeeping services relating to Medicaid funds. See Utah Code 63A-13-102
• State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
• Waste: includes an activity that:
            (13)(b)(i) does not constitute abuse or necessarily involve a violation of law; and
            (13)(b)(ii) relates primarily to mismanagement, an inappropriate action, or inadequate oversight. See Utah Code 63A-13-102