Current as of: 2010
(a) In this part the following words have the meanings indicated.
(b) "False representation" means the knowing and willful:
(1) concealing, falsifying, or omitting of a material fact;
(2) making of a materially false or fraudulent statement; or
(3) use of a document that contains a statement of material fact that the user knows to be false or fraudulent.
(c) (1) "Health care service" means health or medical care procedures, goods, or services that:
(i) provide testing, diagnosis, or treatment of human disease or dysfunction; or
(ii) dispense drugs, medical devices, medical appliances, or medical goods for the treatment of human disease or dysfunction.
(2) "Health care service" includes any procedure, goods, or service that is a required benefit of a State health plan.
(d) "Representation" includes an acknowledgment, certification, claim, ratification, report of demographic statistics, encounter data, enrollment claims, financial information, health care services available or rendered, and qualifications of a person rendering health care or ancillary services.
(e) "Serious injury" means an injury that:
(1) creates a substantial risk of death;
(2) causes serious permanent or serious protracted disfigurement;
(3) causes serious permanent or serious protracted loss of the function of any body part, organ, or mental faculty;
(4) causes serious permanent or serious protracted impairment of the function of any bodily member or organ; or
(5) involves extreme physical pain.
(f) (1) "State health plan" includes:
(i) the State Medical Assistance Plan established in accordance with Title XIX of the federal Social Security Act of 1939;
(ii) a medical assistance plan established by the State; or
(iii) a private health insurance carrier, health maintenance organization, managed care organization as defined in § 15-101 of the Health - General Article, health care cooperative or alliance, or other person that provides or contracts to provide health care services that are wholly or partly reimbursed by or are a required benefit of a health plan established in accordance with Title XIX of the federal Social Security Act of 1939 or by the State.
(2) "State health plan" includes a person that provides or contracts or subcontracts to provide health care services for an entity described in paragraph (1) of this subsection.Prev
Questions & Answers: Criminal Law
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U.S. Code Provisions: Criminal Law