Utah Code > Title 63A > Chapter 13 – Office of Inspector General of Medicaid Services
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Terms Used In Utah Code > Title 63A > Chapter 13 - Office of Inspector General of Medicaid Services
- 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.
- 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
- Allegation: something that someone says happened.
- 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- Contract: A legal written agreement that becomes binding when signed.
- 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 Integrated Healthcare, created in Section 26B-3-102. See Utah Code 63A-13-102
- 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
- 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)(p) Title 58, Chapter 73, Chiropractic Physician Practice Act. See Utah Code 63A-13-102- 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.
- 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- Process: means a writ or summons issued in the course of a judicial proceeding. 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.
- 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.
- 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.
- 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
- 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.
- 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
- 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