Terms Used In Louisiana Revised Statutes > Title 9 > CODE TITLE XXII > Chapter 2 > Part I - Mortgages Securing Several Obligations

• 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 of the following relative to a claim by a provider for payment for a healthcare service rendered by the provider to an enrollee of the Medicaid managed care organization:

              (a) A decision by a managed care organization that denies a claim in whole or in part. See Louisiana Revised Statutes 46:460.51

• 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
• 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.
• 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.
• Applicant: means a healthcare provider seeking to be approved or credentialed by a managed care organization to provide healthcare services to Medicaid enrollees. See Louisiana Revised Statutes 46:460.51
• 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.
• Certificate of documentation: means a certificate issued by the United States Coast Guard for a vessel documented under 46 U. See Louisiana Revised Statutes 34:852.2
• Certificate of origin: means a document establishing the initial chain of ownership, such as a manufacturer's certificate of origin (MCO) or statement of origin (MSO), or an importer's certificate of origin (ICO) or statement of origin (ISO), or a builder's certification (Form CG-1261, under 46 C. See Louisiana Revised Statutes 34:852.2
• 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.
• Dealer: means any person who engages wholly or in part in the business of buying, selling, or exchanging for value new or used vessels or outboard motors, or both, either outright or on conditional sale, bailment, lease, chattel mortgage, or otherwise. See Louisiana Revised Statutes 34:852.2
• Decedent: A deceased person.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Dental coordinated care network: means a managed care organization or prepaid coordinated care network, as defined in this Section, that provides or administers only dental benefits for Medicaid recipients. See Louisiana Revised Statutes 46:460.51
• Department: means the Department of Wildlife and Fisheries and its duly authorized representatives. See Louisiana Revised Statutes 34:852.2
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• 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
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Enrollee: means an individual who is enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• 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.
• Executor: A male person named in a will to carry out the decedent
• 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
• 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
• Hull identification number: means the number assigned to a vessel under Subpart C of 33 C. See Louisiana Revised Statutes 34:852.2
• 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.
• 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.
• 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
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• Legatee: A beneficiary of a decedent
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Lienholder: means a person holding a security interest. See Louisiana Revised Statutes 34:852.2
• 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
• Manufacturer: means any person engaged in the business of manufacturing or importing new vessels or outboard motors for the purpose of sale or trade. See Louisiana Revised Statutes 34:852.2
• 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.
• 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
• Operate: means to navigate or otherwise use a motorboat or vessel. See Louisiana Revised Statutes 34:851.2
• operation: means all operations of a vessel or outboard motor when it is at the pier, idle in the water, at anchor, or being propelled through the water. See Louisiana Revised Statutes 34:852.2
• Order: means a final order imposed pursuant to an administrative adjudication. See Louisiana Revised Statutes 46:437.3
• Outboard motor: means a mechanical combustion engine manufactured to produce a twenty-five or more horsepower engine and designed to attach outboard of the transom of a vessel. See Louisiana Revised Statutes 34:852.2
• Oversight: Committee review of the activities of a Federal agency or program.
• Owner: means a person, other than a secured party, having property rights in, or title to, a vessel or outboard motor. See Louisiana Revised Statutes 34:852.2
• 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
• 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: means any natural person or individual, firm, partnership, corporation, association, limited liability company, or other entity. See Louisiana Revised Statutes 34:852.2
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• 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.
• Policy or procedure: shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services. See Louisiana Revised Statutes 46:460.51
• Possesses: means the person has acquired rights in or title to a vessel or outboard motor by virtue of a gift, donation, raffle, or exchange or the person built the vessel or outboard motor themselves. See Louisiana Revised Statutes 34:852.2
• Prepaid Coordinated Care Network: means a private entity that contracts with the department to provide Medicaid benefits and services to Louisiana Medicaid managed care program enrollees in exchange for a monthly prepaid capitated amount per member. See Louisiana Revised Statutes 46:460.51
• Primary care case management: means a system under which an entity contracts with the state to furnish case management services that include but are not limited to the location, coordination, and monitoring of primary healthcare services to Medicaid beneficiaries. See Louisiana Revised Statutes 46:460.51
• 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 a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• 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
• Quorum: The number of legislators that must be present to do business.
• Recipient: means the person who has received assistance under this Title. See Louisiana Revised Statutes 46:1
• 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
• 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
• 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 secretary of the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• 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
• Security interest: means an interest that is reserved or created by an agreement that secures payment or performance of an obligation. See Louisiana Revised Statutes 34:852.2
• services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
• 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.
• Standardized information: means the customary universal data concerning an applicant's identity, education, and professional experience relative to a managed care organization's credentialing process including but not limited to name, address, telephone number, date of birth, social security number, educational background, state licensing board number, residency program, internship, specialty, subspecialty, fellowship, or certification by a regional or national healthcare or medical specialty college, association or society, prior and current place of employment, an adverse medical review panel opinion, a pending professional liability lawsuit, final disposition of a professional liability settlement or judgment, and information mandated by health insurance issuer accrediting organizations. See Louisiana Revised Statutes 46:460.51
• Telehealth: has the meaning ascribed in La. See Louisiana Revised Statutes 46:460.51
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Undocumented vessel: means a vessel for which a certificate of documentation has not been issued by the United States Coast Guard under 46 U. See Louisiana Revised Statutes 34:852.2
• verification supporting statement: means the documentation confirming the information submitted by an applicant for a credentialing application from a specifically named entity or a regional, national, or general data depository providing primary source verification including but not limited to a college, university, medical school, teaching hospital, healthcare facility or institution, state licensing board, federal agency or department, professional liability insurer, or the National Practitioner Data Bank. See Louisiana Revised Statutes 46:460.51
• 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
• Vessel: means every description of watercraft and air boats, including homemade boats, other than a seaplane on the water, used or capable of being used as a means of transportation on water, valued in excess of two thousand five hundred dollars, to be principally operated on the waters of this state, required to be numbered, not held as inventory for sale or lease, and transferred for the first time on or after July 1, 2008. See Louisiana Revised Statutes 34:852.2
• Watercraft: means any contrivance used or designated for navigation on water. See Louisiana Revised Statutes 34:851.2
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.