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PARRIS N. GLENDENING, Governor
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Ch. 259
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(4) (i) "Health care service" means any health or medical care
procedure, good, or service that:
1. Provides testing, diagnosis, or treatment of human disease
or dysfunction; or
2. Dispenses drugs, medical devices, medical appliances, or
medical goods for the treatment of human disease or dysfunction.
(ii) "Health care service" includes any procedure, good, or service
that is a required benefit of the program.
(5) (i) "Medicaid health plan" means:
1. A state plan established by Title XIX of the Social Security
Act; or
2. A private health insurance carrier, health maintenance
organization, managed care organization, as defined in § 15-101(e) of this subtitle,
health care cooperative or alliance, or other person that provides or contracts to
provide health care services that, in whole or in part, are reimbursed by or are a
required benefit of a state plan established by Title XIX of the Social Security Act.
(ii) "Medicaid health plan" includes a person that provides or
contracts or subcontracts to provide health care services for an entity described in
subparagraph (i) of this paragraph.
(6) "Medicaid health plan fraud" means:
(i) Knowingly defrauding or attempting to defraud a Medicaid
health plan in connection with the delivery of or payment for health care services,
including defrauding or attempting to defraud a Medicaid health plan of the right to
honest services; or
(ii) Knowingly and willfully obtaining or attempting to obtain, by
means of a false representation, money, property, or any thing of value in connection
with the delivery of or payment for health care services that, in whole or in part, are
reimbursed by or are a required benefit of a Medicaid health plan.
(7) "Representation" includes an acknowledgment, certification, claim,
ratification, or report of demographic statistics, encounter data, enrollment claims,
financial information, health care services available or rendered, and the
qualifications of a person that is rendering health care or ancillary services.
(8) "Serious bodily injury" means a bodily injury that involves:
(i) A substantial risk of death;
(ii) Extreme physical pain;
(iii) Protracted and obvious disfigurement; or
(iv) Protracted loss or impairment of the function of a body part,
organ, or mental faculty.
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- 1593 -
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