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2006 LAWS OF MARYLAND
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Ch. 70
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(1) PROMOTES PREVENTION, DETECTION, AND RESOLUTION OF
CONDUCT THAT DOES NOT CONFORM TO THE REQUIREMENTS OF THIS SUBTITLE;
AND
(2) MAY INCLUDE THE FOLLOWING ELEMENTS;
(I) DESIGNATION OF AN INDIVIDUAL WITHIN THE ORGANIZATION
AS THE ORGANIZATION'S COMPLIANCE OFFICER;
(II) A TRAINING PROGRAM REGARDING REIMBURSEMENT
PRINCIPLES;
(III) A HOTLINE TO PROMOTE EFFECTIVE COMMUNICATION;
(IV) PUBLISHED GUIDANCE REGARDING DISCIPLINARY ACTION FOR
CORPORATE OFFICERS, MANAGERS, AND EMPLOYEES WHO FAIL TO COMPLY WITH
THE ORGANIZATION'S BILLING STANDARDS;
(V) PERIODIC REPORTING OF DATA NOT ORDINARILY REQUIRED TO
BE REPORTED; AND
(VI) OTHER PROVISIONS THAT ARE NECESSARY TO COMBAT
MISTAKEN CLAIMS AND FRAUD, WASTE, AND ABUSE "EMPLOYEE" MEANS ANY
INDIVIDUAL WHO PERFORMS SERVICES FOR, OR UNDER THE CONTROL OR
DIRECTION OF, A PROVIDER FOR WAGES OR OTHER REMUNERATION.
(E) (1) "FRAUD" MEANS AN INTENTIONAL MATERIAL DECEPTION OR
MISREPRESENTATION MADE BY A PERSON WITH THE KNOWLEDGE THAT THE
DECEPTION OR MISREPRESENTATION COULD RESULT IN SOME UNAUTHORIZED
BENEFIT OR PAYMENT.
(2) "FRAUD" INCLUDES ANY ACT THAT CONSTITUTES FRAUD UNDER
APPLICABLE STATE OR FEDERAL LAW.
(F) "KNOWING" OR "KNOWINGLY" MEANS THAT, WITH RESPECT TO
INFORMATION, A PERSON:
(1) HAS ACTUAL KNOWLEDGE OF THE INFORMATION;
(2) ACTS IN DELIBERATE IGNORANCE OF THE TRUTH OR FALSITY OF
THE INFORMATION; OR
(3) ACTS IN RECKLESS DISREGARD OF THE TRUTH OR FALSITY OF THE
INFORMATION, AND NO PROOF OF SPECIFIC INTENT TO DEFRAUD IS REQUIRED.
(G) "PROGRAM" MEANS THE MEDICAL ASSISTANCE PROGRAM, THE
CIGARETTE RESTITUTION FUND PROGRAM, THE MENTAL HYGIENE
ADMINISTRATION, THE DEVELOPMENTAL DISABILITIES ADMINISTRATION, THE
ALCOHOL AND DRUG ABUSE ADMINISTRATION, THE FAMILY HEALTH
ADMINISTRATION, THE COMMUNITY HEALTH ADMINISTRATION, OR ANY OTHER UNIT
OF THE DEPARTMENT THAT PAYS A PROVIDER FOR A SERVICE RENDERED OR
CLAIMED TO HAVE BEEN RENDERED TO A RECIPIENT.
- 582 -
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