Terms Used In Louisiana Revised Statutes > Title 46 > Chapter 3 > Part VI-A - Medical Assistance Programs Integrity Law

• Administrative adjudication: means adjudication and the adjudication process contained in the Administrative Procedure Act. See Louisiana Revised Statutes 46:437.3
• 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. See Louisiana Revised Statutes 46:440.12
• 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 and includes the boards, commissions, departments, agencies, offices, officers, and other instrumentalities, or any or all of these, within the executive branch of state government which are abolished by this Title or which are transferred and placed within departments of the state government created and established or continued by this Title or transferred to and placed within the office of the governor as provided by this Title. See Louisiana Revised Statutes 36:3
• Agent: means a person who is employed by or has a contractual relationship with a health care provider or who acts on behalf of the health care provider. See Louisiana Revised Statutes 46:437.3
• 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.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• 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.
• Appraisal: A determination of property value.
• Assistant secretary: means the officer designated by law or by the secretary of each department to carry out the duties and functions of an office within certain departments, except an office of management and finance and the office of state police of the Department of Public Safety and Corrections. See Louisiana Revised Statutes 36:3
• Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Billing agent: means an agent who performs any or all of the health care provider's billing functions. See Louisiana Revised Statutes 46:437.3
• 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

• Commission: means the Louisiana Wildlife and Fisheries Commission. See Louisiana Revised Statutes 34:851.2
• Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
• 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.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Decedent: A deceased person.
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:440.12
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:437.3
• Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
• Deputy secretary: means the officer authorized to be appointed by the secretary to serve as his principal administrative assistant. See Louisiana Revised Statutes 36:3
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Dismissal: The dropping of a case by the judge without further consideration or hearing. ^Source:
• Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. ^{Source: OCC}
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• estate: means a trust or estate, or fiduciary thereof. See Louisiana Revised Statutes 47:300.10
• 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.
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• False or fraudulent claim: means a claim which the health care provider or his billing agent submits knowing the claim to be false, fictitious, untrue, or misleading in regard to any material information. See Louisiana Revised Statutes 46:437.3
• 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.
• Fraud: Intentional deception resulting in injury to another.
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Governing authority: means the governing authority of a parish or parishes having a youth center or a juvenile detention center authority. See Louisiana Revised Statutes 15:1099.2
• Grantor: The person who establishes a trust and places property into it.
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health care provider: means any person furnishing or claiming to furnish a good, service, or supply under the medical assistance programs, any other person defined as a health care provider by federal or state law or by rule, and a provider-in-fact. See Louisiana Revised Statutes 46:437.3
• Houseboat: means a vessel constructed for the primary purpose of a temporary or permanent dwelling without an effective means of propulsion for safe navigation. See Louisiana Revised Statutes 34:851.2
• Indictment: The formal charge issued by a grand jury stating that there is enough evidence that the defendant committed the crime to justify having a trial; it is used primarily for felonies.
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• Judgement: The official decision of a court finally determining the respective rights and claims of the parties to a suit.
• 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.
• Jurisprudence: The study of law and the structure of the legal system.
• knowingly: means that the person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information. See Louisiana Revised Statutes 46:437.3
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Louisiana Colonial Trails: means a system of trails or roads identified as the migration route of the Camino Real in the western part of the state from Natchitoches to the Texas border and the Harrisonburg Road from Natchitoches through east central Louisiana to the Mississippi River. See Louisiana Revised Statutes 56:1952
• Managing employee: means a person who exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operations of a health care provider. See Louisiana Revised Statutes 46:437.3
• Material: means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property. See Louisiana Revised Statutes 46:437.3
• Medical assistance programs: means the Medical Assistance Program (Title XIX of the Social Security Act), commonly referred to as "Medicaid" and other programs operated by and funded in the department which provide payment to health care providers. See Louisiana Revised Statutes 46:437.3
• Misrepresentation: means the knowing failure to truthfully or fully disclose any and all information required, or the concealment of any and all information required on a claim or a provider agreement or the making of a false or misleading statement to the department relative to the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Mortgagee: The person to whom property is mortgaged and who has loaned the money.
• Mortgagor: The person who pledges property to a creditor as collateral for a loan and who receives the money.
• Motorboat: means any vessel equipped with or propelled by any type of machinery whether or not such machinery is the principal source of propulsion but shall not include a vessel which has a valid marine document issued by the Bureau of Customs of the United States Government or any federal agency successor thereto, unless the vessel is a recreational use vessel. See Louisiana Revised Statutes 34:851.2
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Oath: A promise to tell the truth.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Obligation: means an established duty, whether or not fixed, arising from an express or implied contractual, grantor, grantee, or licensor-licensee relationship, from a free-based or similar relationship, from statute or regulation, or from the retention of any overpayment. See Louisiana Revised Statutes 46:437.3
• Office: means each principal operational unit within a department, except the executive office of the secretary. See Louisiana Revised Statutes 36:3
• Operate: means to navigate or otherwise use a motorboat or vessel. See Louisiana Revised Statutes 34:851.2
• Order: means a final order imposed pursuant to an administrative adjudication. See Louisiana Revised Statutes 46:437.3
• Oversight: Committee review of the activities of a Federal agency or program.
• Owner: means a person, other than a lien holder, having a property interest in or title to a motorboat. See Louisiana Revised Statutes 34:851.2
• Ownership interest: means the possession, directly or indirectly, of equity in the capital or the stock, or the right to share in the profits, of a health care provider. See Louisiana Revised Statutes 46:437.3
• Parish: means a parish in which a youth center is sited. See Louisiana Revised Statutes 15:1099.2
• Participating parish: means any parish which has entered into a participation agreement with a parish having a youth center by which certain space within the center is subleased to house juveniles from the participating parish. See Louisiana Revised Statutes 15:1099.2
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• 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
• Person: means an individual, partnership, firm, corporation, association, or other entity. See Louisiana Revised Statutes 34:851.2
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Personal property: All property that is not real property.
• Plaintiff: The person who files the complaint in a civil lawsuit.
• 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.
• Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
• Political subdivision: means a parish, municipality, and any other unit of local government, including a school board and a special district, authorized by law to levy and collect a sales and use tax. See Louisiana Revised Statutes 47:337.6
• Prohibited zone: means an area paralleling each side of the entire length of the Lake Pontchartrain Causeway Bridge and extending outward for a distance of one mile from both the most easterly and westerly outboard sides of the causeway bridge twin spans. See Louisiana Revised Statutes 34:851.2
• Property: means any and all property, movable and immovable, corporeal and incorporeal. 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
• Provider agreement: means a document which is required as a condition of enrollment or participation as a health care provider under the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Provider-in-fact: means an agent who directly or indirectly participates in management decisions, has an ownership interest in the health care provider, or other persons defined as a provider-in-fact by federal or state law or by rule. See Louisiana Revised Statutes 46:437.3
• Quorum: The number of legislators that must be present to do business.
• Recipient: means an individual who is eligible to receive health care through the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Recoupment: means recovery through the reduction, in whole or in part, of payment to a health care provider. See Louisiana Revised Statutes 46:437.3
• 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
• Resident estate: means the estate of a decedent who at his death was domiciled in this state. See Louisiana Revised Statutes 47:300.10
• Resident trust: means a trust or a portion of a trust created by last will and testament of a decedent who at his death was domiciled in this state. See Louisiana Revised Statutes 47:300.10
• Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
• Rule: means any rule or regulation promulgated by the department in accordance with the Administrative Procedure Act and any federal rule or regulation promulgated by the federal government in accordance with federal law. See Louisiana Revised Statutes 46:437.3
• Sailboat: means any watercraft propelled by sail or canvas. See Louisiana Revised Statutes 34:851.2
• Sanction: shall include but is not limited to any or all of the following:

              (a) Recoupment. See Louisiana Revised Statutes 46:437.3

• Secretary: means the secretary of the Louisiana Department of Health, or his authorized designee. See Louisiana Revised Statutes 46:437.3
• Secretary: means the secretary of the Department of Wildlife and Fisheries. See Louisiana Revised Statutes 34:851.2
• Secretary: means the officer appointed by the governor as the executive head and chief administrative officer of certain departments created and provided for by this Title. See Louisiana Revised Statutes 36:3
• Secretary or attorney general: means that either party is authorized to institute a proceeding or take other authorized action as provided in this Part pursuant to a memorandum of understanding between the two so as to notify the public as to whether the secretary or the attorney general is the deciding or controlling party in the proceeding or other authorized matter. See Louisiana Revised Statutes 46:437.3
• 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.
• Statute: A law passed by a legislature.
• Subpoena: A command to a witness to appear and give testimony.
• Subtitle: means and includes all the Chapters in Subtitle II of this Title 47 and any other Title of the Louisiana Revised Statutes of 1950 except the provisions of Chapter 1 of Subtitle IV of Title 47 of the Louisiana Revised Statutes of 1950 and estate taxes for the assessment, collection, administration, and enforcement of taxes, fees, licenses, penalties, and interest due the state of Louisiana which have been delegated to the Department of Revenue. See Louisiana Revised Statutes 47:1501
• Summons: Another word for subpoena used by the criminal justice system.
• Taxable year: includes , in the case of a return made for a fractional part of a year under the provisions of this Chapter or under regulations prescribed by the collector, the period for which return is made. See Louisiana Revised Statutes 47:98
• Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Undersecretary: means the officer designated to direct and be responsible for the functions of the office of management and finance of certain departments. See Louisiana Revised Statutes 36:3
• Verdict: The decision of a petit jury or a judge.
• Vessel: means watercraft and air boats of every description, other than a seaplane on the water, used or capable of being used as a means of transportation on water. See Louisiana Revised Statutes 34:851.2
• Watercraft: means any contrivance used or designated for navigation on water. See Louisiana Revised Statutes 34:851.2
• Waters of the state: means any waters within the territorial limits of this state and the marginal sea adjacent to this state and the high seas when navigated as a part of a journey or ride to or from the shore of this state. See Louisiana Revised Statutes 34:851.2
• Withhold payment: means to reduce or adjust the amount, in whole or in part, to be paid to a health care provider for a pending or future claim during the time of a criminal, civil, or departmental investigation or proceeding or claims review of the health care provider. See Louisiana Revised Statutes 46:437.3
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.