PARRIS N. GLENDENING, Governor                                S.B. 649

(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 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.

(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
FOR HEALTH CARE GOODS OR SERVICES, INCLUDING DEFRAUDING OR
ATTEMPTING TO DEFRAUD A MEDICAID HEALTH PLAN OF THE RIGHT TO HONEST
SERVICES; OR

(II) KNOWINGLY AND WILLFULLY MAKING A FALSE

REPRESENTATION IN CONNECTION WITH THE DELIVERY OF OR PAYMENT FOR
HEALTH CARE GOODS OR SERVICES THAT, IN WHOLE OR IN PART, ARE
REIMBURSED BY OR ARE A REQUIRED BENEFIT OF A MEDICAID HEALTH PLAN.

(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.

(6)      (7) "REPRESENTATION" INCLUDES AN ACKNOWLEDGMENT,
CERTIFICATION, CLAIM, RATIFICATION, OR REPORT OF DEMOGRAPHIC STATISTICS,
ENCOUNTER DATA, ENROLLMENT CLAIMS, FINANCIAL INFORMATION, HEALTH

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