Terms Used In Montana Code 53-6-1408

• Auditor: means an individual or an entity, its agents, subcontractors, and employees that have contracted with the department to perform overpayment audits with respect to the medicaid program. See Montana Code 53-6-1401
• Department: means the department of public health and human services provided for in 2-15-2201. See Montana Code 53-6-1401
• Fraud: Intentional deception resulting in injury to another.
• Fraud: means conduct or activity prohibited by statute, regulation, or rule involving purposeful or knowing conduct or omission to perform a duty that results in or may result in medicaid payments to which a provider is not entitled. See Montana Code 53-6-1401
• Medicaid: means the Montana medical assistance program established under Title 53, chapter 6. See Montana Code 53-6-1401
• Overpayment audit: means a review or audit by the department or an auditor of claims data, medical claims, or other documents in which a purpose or potential result of the review or audit is an overpayment determination. See Montana Code 53-6-1401
• Overpayment determination: means a determination by the department or an auditor that forms the basis for or results in the department:

  (a)partially or completely reducing a medicaid payment to a provider for a claim;

  (b)demanding that the provider repay all or a part of a payment for a claim; or

  (c)using or applying any other method to recoup, recover, or collect from a provider all or part of a payment for a claim. See Montana Code 53-6-1401