As used in this act:

(a) “Claim” means any attempt to cause a health care corporation or health care insurer to make the payment of a health care benefit.

Terms Used In Michigan Laws 752.1002

  • Claim: means any attempt to cause a health care corporation or health care insurer to make the payment of a health care benefit. See Michigan Laws 752.1002
  • Contract: A legal written agreement that becomes binding when signed.
  • 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.
  • Deceptive: means making a claim to a health care corporation or health care insurer which contains a statement of fact or which fails to reveal a material fact, which statement or failure leads the health care corporation or health care insurer to believe the represented or suggested state of affair to be other than it actually is. See Michigan Laws 752.1002
  • Health care benefit: means the right under a contract or a certificate or policy of insurance to have a payment made by a health care corporation or health care insurer for a specified health care service. See Michigan Laws 752.1002
  • Health care corporation: means a nonprofit dental care corporation incorporated under Act No. See Michigan Laws 752.1002
  • Health care insurer: means any insurance company authorized to provide health insurance in this state or any legal entity which is self-insured and providing health care benefits to its employees. See Michigan Laws 752.1002
  • Health facility or agency: means a health facility or agency, as defined in section 20106 of the public health code, Act No. See Michigan Laws 752.1002
  • 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.
  • Person: means an individual, corporation, partnership, association, or any other legal entity. See Michigan Laws 752.1002
  • state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o

(b) “Deceptive” means making a claim to a health care corporation or health care insurer which contains a statement of fact or which fails to reveal a material fact, which statement or failure leads the health care corporation or health care insurer to believe the represented or suggested state of affair to be other than it actually is.

(c) “False” means wholly or partially untrue or deceptive.

(d) “Health care benefit” means the right under a contract or a certificate or policy of insurance to have a payment made by a health care corporation or health care insurer for a specified health care service.

(e) “Health care corporation” means a nonprofit dental care corporation incorporated under Act No. 125 of the Public Acts of 1963, being sections 550.351 to 550.373 of the Michigan Compiled Laws; a hospital service corporation, medical care corporation, or a consolidated hospital service corporation and medical care corporation incorporated or reincorporated under Act No. 350 of the Public Acts of 1980, being sections 550.1101 to 550.1704 of the Michigan Compiled Laws, or incorporated or consolidated under Act No. 108 or 109 of the Public Acts of 1939; or a health maintenance organization licensed under Act No. 368 of the Public Acts of 1978, being sections 333.1101 to 333.25211 of the Michigan Compiled Laws.

(f) “Health care insurer” means any insurance company authorized to provide health insurance in this state or any legal entity which is self-insured and providing health care benefits to its employees.

(g) “Health facility or agency” means a health facility or agency, as defined in section 20106 of the public health code, Act No. 368 of the Public Acts of 1978, being section 333.20106 of the Michigan Compiled Laws.

(h) “Knowing” and “knowingly” means that a person is in possession of facts under which he or she is aware or should be aware of the nature of his or her conduct and that his or her conduct is substantially certain to cause the payment of a health care benefit. “Knowing” or “knowingly” does not include conduct which is an error or mistake unless the person’s course of conduct indicates a systematic or persistent tendency to cause inaccuracies to be present.

(i) “Person” means an individual, corporation, partnership, association, or any other legal entity.