Louisiana Revised Statutes 46:440.12 – As used in this Subpart, the following terms have the meaning ascribed in this Section:
Terms Used In Louisiana Revised Statutes 46:440.12
- 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
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:440.12
- 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
- Provider: means any healthcare entity enrolled with the department as a provider in the Medicaid program. See Louisiana Revised Statutes 46:440.12
- 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
As used in this Subpart, the following terms have the meaning ascribed in this Section:
(1) “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.
(2) “Contractor” and “recovery audit contractor” mean a Medicaid recovery audit contractor selected by the department to perform audits for the purpose of ensuring Medicaid program integrity in accordance with the provisions of 42 C.F.R. § part 455 et seq.
(3) “Department” means the Louisiana Department of Health.
(4) “Medicaid” and “medical assistance program” mean the medical assistance program provided for in Title XIX of the Social Security Act.
(5) “Provider” means any healthcare entity enrolled with the department as a provider in the Medicaid program.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.