Terms Used In Rhode Island General Laws > Chapter 40-8.2 - Medical Assistance Fraud

• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Benefit: means pecuniary benefit as defined herein. See Rhode Island General Laws 40-8.2-2
• Claim: means any request for payment, electronic or otherwise, and shall also include any data commonly known as encounter data, that is used, or is to be used, for the development of a capitation fee payable to a provider of managed healthcare goods, merchandise, or services. See Rhode Island General Laws 40-8.2-2
• 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.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• 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:
• 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.
• Executive office: means the executive office of health and human services, the agency designated by state law and the Medicaid state plan as the Medicaid single state agency. See Rhode Island General Laws 40-8.2-2
• 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.
• in writing: include printing, engraving, lithographing, and photo-lithographing, and all other representations of words in letters of the usual form. See Rhode Island General Laws 43-3-16
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Interrogatories: Written questions asked by one party of an opposing party, who must answer them in writing under oath; a discovery device in a lawsuit.
• 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.
• Kickback: means a return in any form by any individual of a part of an expenditure made by a provider:

  (i)  To the same provider;

  (ii)  To an entity controlled by the provider; or

  (iii)  To an entity that the provider intends to benefit whenever the expenditure is reimbursed, or reimbursable, or claimed by a provider as being reimbursable by the Rhode Island Medicaid program and when the sum or value returned is not credited to the benefit of the Rhode Island Medicaid program. See Rhode Island General Laws 40-8.2-2

• Medicaid fraud control unit: means a duly certified Medicaid fraud control unit under federal regulation authorized to perform those functions as described by § 1903(q) of the Social Security Act, 42 U. See Rhode Island General Laws 40-8.2-2
• Medically unnecessary services or merchandise: means services or merchandise provided to recipients intentionally without any expectation that the services or merchandise will alleviate or aid the recipient's medical condition. See Rhode Island General Laws 40-8.2-2
• Oath: A promise to tell the truth.
• oath: includes affirmation; the word "sworn" includes affirmed; and the word "engaged" includes either sworn or affirmed. See Rhode Island General Laws 43-3-11
• 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 any person or individual, natural or otherwise, and includes those person(s) or entities defined by the term "provider. See Rhode Island General Laws 40-8.2-2
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Provider: means any individual, individual medical vendor, firm, corporation, professional association, partnership, organization, or other legal entity that provides goods or services under the Rhode Island Medicaid program, or the employee of any person or entity who, on his or her own behalf, or on the behalf of his or her employer, knowingly performs any act or is knowingly responsible for an omission prohibited by this chapter. See Rhode Island General Laws 40-8.2-2
• Recipient: means any person receiving medical assistance under the Rhode Island Medicaid program. See Rhode Island General Laws 40-8.2-2
• Records: means all documents developed by a provider and related to the provision of services reimbursed or claimed as reimbursable by the Rhode Island Medicaid program. See Rhode Island General Laws 40-8.2-2
• Rhode Island Medicaid program: means a state-administered, medical assistance program that is funded by the state and federal governments under Title XIX and Title XXI of the U. See Rhode Island General Laws 40-8.2-2
• Statute: A law passed by a legislature.
• Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
• Subpoena: A command to a witness to appear and give testimony.
• Subpoena duces tecum: A command to a witness to produce documents.
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• United States: include the several states and the territories of the United States. See Rhode Island General Laws 43-3-8