Ch. 713

1997 LAWS OF MARYLAND

(II) A PRIVATE HEALTH INSURANCE CARRIER, HEALTH
MAINTENANCE ORGANIZATION, HEALTH CARE COOPERATIVE OR ALLIANCE, OR
OTHER PERSON THAT PROVIDES OR CONTRACTS TO PROVIDE HEALTH CARE GOODS
OR SERVICES THAT ARE REIMBURSED BY OR ARE A REQUIRED BENEFIT OF A STATE
PLAN ESTABLISHED BY TITLE XIX OF THE SOCIAL SECURITY ACT OF 1939; OR

(III) A PERSON THAT PROVIDES, CONTRACTS, OR SUBCONTRACTS
TO PROVIDE HEALTH CARE GOODS OR SERVICES FOR AN ENTITY DESCRIBED IN
SUBPARAGRAPH (I) OR (II) OF THIS PARAGRAPH.

(3) "FALSE REPRESENTATION" MEANS:

(I)      KNOWINGLY AND WILLFULLY CONCEALING, FALSIFYING. OR
OMITTING A MATERIAL FACT; OR

(II)    KNOWINGLY AND WILLFULLY MAKING A MATERIALLY FALSE
OR FRAUDULENT STATEMENT OR USING A DOCUMENT THAT CONTAINS A
MATERIALLY FALSE OR FRAUDULENT STATEMENT.

(4) (I) "HEALTH CARE SERVICE" MEANS ANY HEALTH OR MEDICAL
CARE PROCEDURE GOOD, OR SERVICE RENDERED BY A HEALTH CARE PROVIDER
THAT:

(I) 1. PROVIDES TESTING. DIAGNOSIS. OR TREATMENT OF
HUMAN DISEASE OR DYSFUNCTION; OR

(II) 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 FLAN" 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.

(5) (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

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