Terms Used In Louisiana Revised Statutes > Title 46 > Chapter 3 > Part VI-A - Medical Assistance Programs Integrity Law

• Administrative adjudication: means adjudication and the adjudication process contained in the Administrative Procedure Act. See Louisiana Revised Statutes 46:437.3
• Administrator: means the person who is responsible for the administration of the motor vehicle service contract or the motor vehicle service contract plan or who is responsible for any submission required by this Chapter. See Louisiana Revised Statutes 51:3162
• Adverse determination: means any of the following relative to a claim by a provider for payment for a healthcare service rendered by the provider to an enrollee of the Medicaid managed care organization:

              (a) A decision by a managed care organization that denies a claim in whole or in part. See Louisiana Revised Statutes 46:460.51

• Adverse determination: means any decision rendered by the recovery audit contractor that results in a payment to a provider for a claim or service being reduced either partially or completely. See Louisiana Revised Statutes 46:440.12
• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Agency: means and includes the boards, commissions, departments, agencies, offices, officers, and other instrumentalities, or any or all of these, within the executive branch of state government which are abolished by this Title or which are transferred and placed within departments of the state government created and established or continued by this Title or transferred to and placed within the office of the governor as provided by this Title. See Louisiana Revised Statutes 36:3
• Agent: means a person who is employed by or has a contractual relationship with a health care provider or who acts on behalf of the health care provider. See Louisiana Revised Statutes 46:437.3
• Agreement: means a written contractual agreement between the merchant and the third-party delivery service. See Louisiana Revised Statutes 51:3171
• Allegation: something that someone says happened.
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appraisal: A determination of property value.
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Arrest: Taking physical custody of a person by lawful authority.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Assistant secretary: means the officer designated by law or by the secretary of each department to carry out the duties and functions of an office within certain departments, except an office of management and finance and the office of state police of the Department of Public Safety and Corrections. See Louisiana Revised Statutes 36:3
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Billing agent: means an agent who performs any or all of the health care provider's billing functions. See Louisiana Revised Statutes 46:437.3
• Buyer: means an individual who is solicited to purchase or who purchases the services of a credit repair services organization. See Louisiana Revised Statutes 9:3573.2
• Chambers: A judge's office.
• Claim: means any request or demand, whether under a contract or otherwise, for money or property, whether or not the state or department has title to the money or property, that is drawn in whole or in part on medical assistance programs funds that are either of the following:

              (a) Presented to an officer, employee, or agent of the state or department. See Louisiana Revised Statutes 46:437.3

• commerce: means the advertising, offering for sale, sale, or distribution of any services, including educational services, and any property, corporeal or incorporeal, immovable or movable, and any other article, commodity, or thing of value wherever situated, and includes any trade or commerce directly or indirectly affecting the people of this state. See Louisiana Revised Statutes 51:3211
• Commercial recording or audiovisual work: means a recording or audiovisual work whose owner, assignee, authorized agent, or licensee has disseminated or intends to disseminate for sale, rental, performance, or exhibition to the public, including under license, but does not include an excerpt consisting of less than substantially all of a recording or audiovisual work. See Louisiana Revised Statutes 51:3232
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Consumer: means a natural person who buys, other than for purposes of resale, any corporeal movable property, including a motor vehicle, that is distributed in commerce and that is normally used for personal, family, or household purposes and not for business or research purposes. See Louisiana Revised Statutes 51:3162
• Consumer: means a person, business, or other entity who places an order for merchant products through the third-party delivery platform. See Louisiana Revised Statutes 51:3171
• Consumer: means any individual who uses, purchases, or leases goods or services. See Louisiana Revised Statutes 51:3211
• Consumer: means a natural person who purchases goods, services, or movable or immovable property or rights therein, for a personal, family, or household purpose and includes a purchaser or buyer in a consumer credit sale or transaction made with the use of a seller credit card or otherwise, or a borrower or debtor in a consumer loan, revolving loan account, or a lender credit card. See Louisiana Revised Statutes 9:3516
• Continuance: Putting off of a hearing ot trial until a later time.
• Contract: A legal written agreement that becomes binding when signed.
• contract holder: means a person who is the purchaser or holder of a motor vehicle service contract. See Louisiana Revised Statutes 51:3162
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Credit repair services organization: means a person who, with respect to a buyer, in return for the payment of money or other valuable consideration, directly or indirectly, provides or represents that he can or will, directly or indirectly, provide any of the following services:

  (a)  Improving a buyer's credit record, history, or rating. See Louisiana Revised Statutes 9:3573.2

• current status: includes valid, expired, cancelled, suspended, disqualified, active, inactive, member, nonmember, eligible, or ineligible. See Louisiana Revised Statutes 51:3211
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Dental coordinated care network: means a managed care organization or prepaid coordinated care network, as defined in this Section, that provides or administers only dental benefits for Medicaid recipients. See Louisiana Revised Statutes 46:460.51
• Department: means the Department of Children and Family Services or the Louisiana Department of Health. See Louisiana Revised Statutes 46:1
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:437.3
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:440.12
• Dependent: A person dependent for support upon another.
• Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
• Deputy secretary: means the officer authorized to be appointed by the secretary to serve as his principal administrative assistant. See Louisiana Revised Statutes 36:3
• Digitized identification card: means a data file available on any mobile device which has connectivity to the internet through a state-approved application that allows the mobile device to download the data file from the Department of Public Safety and Corrections or an authorized representative of the Department of Public Safety and Corrections that contains all of the data elements visible on the face and back of a license or identification card and displays the current status of the license or identification card. See Louisiana Revised Statutes 51:3211
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Electronic dissemination: means initiating a transmission of, making available, or otherwise offering a commercial recording or audiovisual work for distribution, display, or performance through the internet or other digital network, regardless of whether another person has previously electronically disseminated the same commercial recording or audiovisual work. See Louisiana Revised Statutes 51:3232
• Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. ^{Source: OCC}
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Executive session: A portion of the Senate's daily session in which it considers executive business.
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• False or fraudulent claim: means a claim which the health care provider or his billing agent submits knowing the claim to be false, fictitious, untrue, or misleading in regard to any material information. See Louisiana Revised Statutes 46:437.3
• Fiduciary: A trustee, executor, or administrator.
• 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.
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Grantor: The person who establishes a trust and places property into it.
• Health care provider: means any person furnishing or claiming to furnish a good, service, or supply under the medical assistance programs, any other person defined as a health care provider by federal or state law or by rule, and a provider-in-fact. See Louisiana Revised Statutes 46:437.3
• High-volume third-party seller: means a participant on an online marketplace's platform who is a third-party seller and who has entered into two hundred or more discrete sales or transactions of new or unused consumer products in any twelve-month period during the previous twenty-four months, which result in an aggregate total of five thousand dollars or more in total gross revenue. See Louisiana Revised Statutes 51:3261
• Hospital health services: means but is not limited to any clinical, diagnostic, or rehabilitation service and any administrative, managerial, or operational service incident thereto. See Louisiana Revised Statutes 46:1072
• Hospital service district: means :

             (a) A political subdivision of the state of Louisiana organized pursuant to an Act of the Legislature of Louisiana or pursuant to Louisiana Revised Statutes 46:1072

• Hospital service district commission: means the governing authority or managing board of a hospital service district as defined herein. See Louisiana Revised Statutes 46:1072
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• Indictment: The formal charge issued by a grand jury stating that there is enough evidence that the defendant committed the crime to justify having a trial; it is used primarily for felonies.
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Inter vivos: Transfer of property from one living person to another living person.
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• 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.
• knowingly: means that the person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information. See Louisiana Revised Statutes 46:437.3
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Likeness: means the logo, motto, or any identifiable symbols attributed and easily identified as belonging to a specific merchant. See Louisiana Revised Statutes 51:3171
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Louisiana Colonial Trails: means a system of trails or roads identified as the migration route of the Camino Real in the western part of the state from Natchitoches to the Texas border and the Harrisonburg Road from Natchitoches through east central Louisiana to the Mississippi River. See Louisiana Revised Statutes 56:1952
• Managing employee: means a person who exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operations of a health care provider. See Louisiana Revised Statutes 46:437.3
• Market strategies: means any plan, strategy, or device developed or intended to promote, sell, or offer to sell any hospital health service. See Louisiana Revised Statutes 46:1072
• Material: means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property. See Louisiana Revised Statutes 46:437.3
• Medical assistance programs: means the Medical Assistance Program (Title XIX of the Social Security Act), commonly referred to as "Medicaid" and other programs operated by and funded in the department which provide payment to health care providers. See Louisiana Revised Statutes 46:437.3
• Merchant: means a restaurant or other retail entity. See Louisiana Revised Statutes 51:3171
• Misrepresentation: means the knowing failure to truthfully or fully disclose any and all information required, or the concealment of any and all information required on a claim or a provider agreement or the making of a false or misleading statement to the department relative to the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Motor vehicle manufacturer: means a person who is any of the following:

              (a) A manufacturer or producer of motor vehicles who sells motor vehicles under the manufacturer's or producer's own name or label. See Louisiana Revised Statutes 51:3162

• Motor vehicle service contract: means a contract or agreement for a separately stated consideration for any duration to perform the service, repair, replacement, or maintenance of property or indemnification for service, repair, replacement, or maintenance, for the operational or structural failure of any motor vehicle due to a defect in materials, workmanship, inherent defect, or normal wear and tear, with or without additional provisions for incidental payment or indemnity under limited circumstances, including but not limited to towing, rental, and emergency road service and road hazard protection. See Louisiana Revised Statutes 51:3162
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Oath: A promise to tell the truth.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Obligation: means an established duty, whether or not fixed, arising from an express or implied contractual, grantor, grantee, or licensor-licensee relationship, from a free-based or similar relationship, from statute or regulation, or from the retention of any overpayment. See Louisiana Revised Statutes 46:437.3
• Office: means each principal operational unit within a department, except the executive office of the secretary. See Louisiana Revised Statutes 36:3
• Online marketplace: means any person or entity that operates a consumer-directed electronically based or accessed platform that meets all of the following criteria:

              (a) Has features that allow for, facilitate, or enable third-party sellers to engage in the sale, purchase, payment, storage, shipping, or delivery of a consumer product in this state. See Louisiana Revised Statutes 51:3261

• Order: means a final order imposed pursuant to an administrative adjudication. See Louisiana Revised Statutes 46:437.3
• Organization: means corporation, government or governmental subdivision or agency, trust, estate, partnership, cooperative, or association. See Louisiana Revised Statutes 9:3516
• Oversight: Committee review of the activities of a Federal agency or program.
• Ownership interest: means the possession, directly or indirectly, of equity in the capital or the stock, or the right to share in the profits, of a health care provider. See Louisiana Revised Statutes 46:437.3
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Payment: means the payment to a health care provider from medical assistance programs funds pursuant to a claim, or the attempt to seek payment for a claim. See Louisiana Revised Statutes 46:437.3
• Person: means an individual, partnership, corporation, incorporated or unincorporated association, joint stock company, reciprocal, syndicate, or any similar entity or combination of entities acting in concert. See Louisiana Revised Statutes 51:3162
• Person: means any individual, firm, partnership, corporation, association, union, public or private education institution, or other organization, including but not limited to a bar or restaurant that is engaged in trade or commerce within the geographic boundaries of this state. See Louisiana Revised Statutes 51:3211
• Person: means an individual, corporation, partnership, trust, association, joint venture pool, syndicate, sole proprietorship, unincorporated organization, or any other form of entity not specifically listed herein. See Louisiana Revised Statutes 9:3573.2
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Personal property: All property that is not real property.
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
• Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
• Property: means any and all property, movable and immovable, corporeal and incorporeal. See Louisiana Revised Statutes 46:437.3
• Provider: means a person who is contractually obligated to provide the services or indemnification under a motor vehicle service contract. See Louisiana Revised Statutes 51:3162
• provider: means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• Provider: means any healthcare entity enrolled with the department as a provider in the Medicaid program. See Louisiana Revised Statutes 46:440.12
• Provider agreement: means a document which is required as a condition of enrollment or participation as a health care provider under the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Provider fee: means the consideration paid for a motor vehicle service contract. See Louisiana Revised Statutes 51:3162
• Provider-in-fact: means an agent who directly or indirectly participates in management decisions, has an ownership interest in the health care provider, or other persons defined as a provider-in-fact by federal or state law or by rule. See Louisiana Revised Statutes 46:437.3
• Recipient: means an individual who is eligible to receive health care through the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Recoupment: means recovery through the reduction, in whole or in part, of payment to a health care provider. See Louisiana Revised Statutes 46:437.3
• Recovery: means the recovery of overpayments, damages, fines, penalties, costs, expenses, restitution, attorney fees, or interest or settlement amounts. See Louisiana Revised Statutes 46:437.3
• Reimbursement insurance policy: means a policy of insurance issued to a provider to do either of the following:

              (a) Provide reimbursement to the provider pursuant to the terms of the insured motor vehicle service contracts issued or sold by the provider. See Louisiana Revised Statutes 51:3162

• Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
• Rule: means any rule or regulation promulgated by the department in accordance with the Administrative Procedure Act and any federal rule or regulation promulgated by the federal government in accordance with federal law. See Louisiana Revised Statutes 46:437.3
• Sanction: shall include but is not limited to any or all of the following:

              (a) Recoupment. See Louisiana Revised Statutes 46:437.3

• Secretary: means the officer appointed by the governor as the executive head and chief administrative officer of certain departments created and provided for by this Title. See Louisiana Revised Statutes 36:3
• Secretary: means the secretary of the Louisiana Department of Health, or his authorized designee. See Louisiana Revised Statutes 46:437.3
• Secretary: means the secretary of the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Secretary or attorney general: means that either party is authorized to institute a proceeding or take other authorized action as provided in this Part pursuant to a memorandum of understanding between the two so as to notify the public as to whether the secretary or the attorney general is the deciding or controlling party in the proceeding or other authorized matter. See Louisiana Revised Statutes 46:437.3
• Service of process: The service of writs or summonses to the appropriate party.
• services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Statute: A law passed by a legislature.
• Strategic plans: means any plan, strategy, or device developed or intended to construct, operate, maintain a health facility or engage in providing, promoting, or selling a hospital health service. See Louisiana Revised Statutes 46:1072
• Subpoena: A command to a witness to appear and give testimony.
• Subtitle: means and includes all the Chapters in Subtitle II of this Title 47 and any other Title of the Louisiana Revised Statutes of 1950 except the provisions of Chapter 1 of Subtitle IV of Title 47 of the Louisiana Revised Statutes of 1950 and estate taxes for the assessment, collection, administration, and enforcement of taxes, fees, licenses, penalties, and interest due the state of Louisiana which have been delegated to the Department of Revenue. See Louisiana Revised Statutes 47:1501
• Summons: Another word for subpoena used by the criminal justice system.
• Taxable year: includes , in the case of a return made for a fractional part of a year under the provisions of this Chapter or under regulations prescribed by the collector, the period for which return is made. See Louisiana Revised Statutes 47:98
• Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Third-party delivery platform: means the online communication platform of the third-party delivery service on which a consumer can view and search the menus of merchants and place an order for merchant products through internet-enabled technology and digital media, including websites and consumer applications accessible through smart phones and other mobile devices. See Louisiana Revised Statutes 51:3171
• Third-party delivery service: means a company, organization, or other entity, other than a merchant, that is licensed to do business in this state and provides limited delivery services to a consumer. See Louisiana Revised Statutes 51:3171
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Undersecretary: means the officer designated to direct and be responsible for the functions of the office of management and finance of certain departments. See Louisiana Revised Statutes 36:3
• Venue: The geographical location in which a case is tried.
• Verdict: The decision of a petit jury or a judge.
• Verify: means to confirm information provided to an online marketplace pursuant to this Chapter, which may include the use of one or more methods that enable the online marketplace to reliably determine that any information and documents provided are valid, corresponding to the seller or an individual acting on the seller's behalf, not misappropriated, and not falsified. See Louisiana Revised Statutes 51:3261
• Website: means a set of related webpages served from a single web domain. See Louisiana Revised Statutes 51:3232
• Withhold payment: means to reduce or adjust the amount, in whole or in part, to be paid to a health care provider for a pending or future claim during the time of a criminal, civil, or departmental investigation or proceeding or claims review of the health care provider. See Louisiana Revised Statutes 46:437.3
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.