Utah Code > Title 31A > Chapter 9 > Part 4 – Management of Fraternals
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Terms Used In Utah Code > Title 31A > Chapter 9 > Part 4 - Management of Fraternals
- 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
- Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
- 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 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
- Agency: means :
(6)(a) a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and(6)(b) an insurance organization licensed or required to be licensed under Section31A-23a-301 ,31A-25-207 , or31A-26-209 . See Utah Code 31A-1-301- 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.
- 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.
- board of directors: means the group of persons with responsibility over, or management of, a corporation, however designated. See Utah Code 31A-1-301
- Claimant: means a person that:
(2)(a) provides a service; and(2)(b) submits a claim for Medicaid reimbursement for the service. See Utah Code 63A-13-102- Commission: means the Independent Executive Branch Ethics Commission, created in Section 63A-14-202. See Utah Code 63A-14-102
- Complainant: means an individual who files a complaint under Subsection 63A-14-402(1)(a). See Utah Code 63A-14-102
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Conviction: A judgement of guilt against a criminal defendant.
- Department: means the Department of Government Operations. See Utah Code 63A-1-103
- Department: means the Department of Health and Human Services created in Section 26B-1-201. See Utah Code 63A-13-102
- Director: means a member of the board of directors of a corporation. See Utah Code 31A-1-301
- 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 Archives and Records Service. See Utah Code 63A-12-100.5
- Division: means the Division of Integrated Healthcare, created in Section 26B-3-102. See Utah Code 63A-13-102
- Enrolled bill: The final copy of a bill or joint resolution which has passed both chambers in identical form. It is printed on parchment paper, signed by appropriate officials, and submitted to the President/Governor for signature.
- Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
- 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 branch agency: includes a state agency, as defined in Subsection 67-1-17(1)(d). See Utah Code 63A-12-100.5
- Executive branch elected official: means :
(3)(a) the governor;(3)(b) the lieutenant governor;(3)(c) the state auditor;(3)(d) the state treasurer; or(3)(e) the attorney general. See Utah Code 63A-14-102- Executive director: means the executive director of the Department of Government Operations. See Utah Code 63A-1-103
- Extrapolation: means a method of using a mathematical formula that takes the audit results from a small sample of Medicaid claims and projects those results over a much larger group of Medicaid claims. See Utah Code 63A-13-102
- 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.
- Form: means one of the following prepared for general use:
(74)(a)(i) a policy;(74)(a)(ii) a certificate;(74)(a)(iii) an application;(74)(a)(iv) an outline of coverage; or(74)(a)(v) an endorsement. See Utah Code 31A-1-301- 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)(p) Title 58, Chapter 73, Chiropractic Physician Practice Act. See Utah Code 63A-13-102- Impeachment: (1) The process of calling something into question, as in "impeaching the testimony of a witness." (2) The constitutional process whereby the House of Representatives may "impeach" (accuse of misconduct) high officers of the federal government for trial in the Senate.
- Improper purpose: includes harassing a respondent, causing unwarranted harm to a respondent's reputation, or causing unnecessary expenditure of public funds. See Utah Code 63A-14-102
- 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
- Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
- Inspector general: means the inspector general of the office, appointed under Section 63A-13-201. See Utah Code 63A-13-102
- Insurance: includes :
(96)(b)(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;(96)(b)(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and(96)(b)(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301- 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.
- Laws of a fraternal: include its articles of incorporation and bylaws, however designated. See Utah Code 31A-9-101
- Legislative session: That part of a chamber's daily session in which it considers legislative business (bills, resolutions, and actions related thereto).
- Malfeasance in office: means an intentional act or omission relating to the duties of an executive branch elected official that:
(5)(a) constitutes a crime; or(5)(b)(5)(b)(i) constitutes a substantial breach of the trust imposed upon the executive branch elected official by the nature of the official's office; and(5)(b)(ii) is against commonly accepted standards of honesty and morality. See Utah Code 63A-14-102- Member: means a person having membership rights in an insurance corporation. See Utah Code 31A-1-301
- Mutual: means a mutual insurance corporation. See Utah Code 31A-1-301
- Office: means the Office of Inspector General of Medicaid Services, created in Section 63A-13-201. See Utah Code 63A-13-102
- Oversight: Committee review of the activities of a Federal agency or program.
- 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- Personal identifying information: includes information identified as personal identifying information in accordance with the rules described in Section 63A-12-104. See Utah Code 63A-12-100.5
- 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.
- Privacy annotation: means a summary, described in Subsection 63A-12-115(2) and rules made by the executive director under Subsection 63A-12-104(2), that, for each record series that an executive branch agency collects, maintains, or uses:
(2)(d)(i) discloses whether the record series contains personal identifying information; and(2)(d)(ii) if the record series contains personal identifying information, includes the information described in Subsection 63A-12-115(2)(b). See Utah Code 63A-12-100.5- Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
- Property: includes both real and personal property. 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- Quorum: The number of legislators that must be present to do business.
- Record: means :
(2)(e)(i) the same as that term is defined in Section 63G-2-103; or(2)(e)(ii) a video or audio recording of an interview, or a transcript of the video or audio recording, that is conducted at a Children's Justice Center established under Section 67-5b-102, the release of which is governed by Section 77-37-4. See Utah Code 63A-12-100.5- Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
- Respondent: means the executive branch elected official against whom an ethics complaint described in Section 63A-14-402 is filed. See Utah Code 63A-14-102
- 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.
- Signature: includes a name, mark, or sign written with the intent to authenticate an instrument or writing. See Utah Code 68-3-12.5
- 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
- State archives: means the Division of Archives and Records Service. See Utah Code 63A-12-100.5
- Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
- Subpoena: A command to a witness to appear and give testimony.
- Testify: Answer questions in court.
- Testify: means to make an oral statement under oath or affirmation. See Utah Code 68-3-12.5
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
- Transcript: A written, word-for-word record of what was said, either in a proceeding such as a trial or during some other conversation, as in a transcript of a hearing or oral deposition.
- United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
- Upcoding: means assigning an inaccurate billing code for a service that is payable or reimbursable by Medicaid funds, if the correct billing code for the service, taking into account reasonable opinions derived from official published coding definitions, would result in a lower Medicaid payment or reimbursement. See Utah Code 63A-13-102
- Utah Code: means the 1953 recodification of the Utah Code, as amended, unless the text expressly references a portion of the 1953 recodification of the Utah Code as it existed:
(42)(a) on the day on which the 1953 recodification of the Utah Code was enacted; or(42)(b)(42)(b)(i) after the day described in Subsection (42)(a); and(42)(b)(ii) before the most recent amendment to the referenced portion of the 1953 recodification of the Utah Code. See Utah Code 68-3-12.5- Violation: means a high crime, a misdemeanor, or malfeasance in office. See Utah Code 63A-14-102
- Vulnerable adult: means the same as that term is defined in Section 26B-6-201. See Utah Code 63A-12-100.5
- Vulnerable record: means a record or data relating to:
(2)(h)(i) national security interests;(2)(h)(ii) the care, custody, or control of a child;(2)(h)(iii) a fiduciary trust over money;(2)(h)(iv) health care of a child; or(2)(h)(v) the following, in relation to a vulnerable adult:(2)(h)(v)(A) protection, health care, or other care; or(2)(h)(v)(B) the provision of food, shelter, clothing, assistance with an activity of daily living, or assistance with financial resource management. See Utah Code 63A-12-100.5- 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- Writing: includes :
(48)(a) printing;(48)(b) handwriting; and(48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5