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PARRIS N. GLENDENING, Governor
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H.B. 354
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(2) "HEALTH CARE SERVICE" INCLUDES ANY PROCEDURE, GOODS, OR
SERVICE THAT IS A REQUIRED BENEFIT OF A STATE HEALTH PLAN.
(D) "REPRESENTATION" INCLUDES AN ACKNOWLEDGMENT, CERTIFICATION,
CLAIM, RATIFICATION, REPORT OF DEMOGRAPHIC STATISTICS, ENCOUNTER DATA,
ENROLLMENT CLAIMS, FINANCIAL INFORMATION, HEALTH CARE SERVICES
AVAILABLE OR RENDERED, AND QUALIFICATIONS OF A PERSON RENDERING HEALTH
CARE OR ANCILLARY SERVICES.
(E) "SERIOUS INJURY" MEANS AN INJURY THAT:
(1) CREATES A SUBSTANTIAL RISK OF DEATH; .
(2) CAUSES SERIOUS PERMANENT OR SERIOUS PROTRACTED
DISFIGUREMENT;
(3) CAUSES SERIOUS PERMANENT OR SERIOUS PROTRACTED LOSS OF
THE FUNCTION OF ANY BODY PART, ORGAN, OR MENTAL FACULTY;
(4) CAUSES SERIOUS PERMANENT OR SERIOUS PROTRACTED
IMPAIRMENT OF THE FUNCTION OF ANY BODILY MEMBER OR. ORGAN; OR
(5) INVOLVES EXTREME PHYSICAL PAIN.
(F) (1) "STATE HEALTH PLAN" INCLUDES:
(I) THE STATE MEDICAL ASSISTANCE PLAN ESTABLISHED IN
ACCORDANCE WITH TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT OF 1939;
(II) A MEDICAL ASSISTANCE PLAN ESTABLISHED BY THE STATE; OR
(III) A PRIVATE HEALTH INSURANCE CARRIER, HEALTH
MAINTENANCE ORGANIZATION, MANAGED CARE ORGANIZATION AS DEFINED IN §
15-101 OF THE HEALTH - GENERAL ARTICLE, HEALTH CARE COOPERATIVE OR
ALLIANCE, OR OTHER PERSON THAT PROVIDES OR CONTRACTS TO PROVIDE HEALTH
CARE SERVICES THAT ARE WHOLLY OR PARTLY REIMBURSED BY OR ARE A
REQUIRED BENEFIT OF A HEALTH PLAN ESTABLISHED IN ACCORDANCE WITH TITLE
XIX OF THE FEDERAL SOCIAL SECURITY ACT OF 1939 OR BY THE STATE.
(2) "STATE HEALTH PLAN" INCLUDES A PERSON THAT PROVIDES OR
CONTRACTS OR SUBCONTRACTS TO PROVIDE HEALTH CARE SERVICES FOR AN
ENTITY DESCRIBED IN PARAGRAPH (1) OF THIS SUBSECTION.
230C.
A PERSON MAY NOT:
(1) WILLFULLY KNOWINGLY AND WILLFULLY DEFRAUD OR ATTEMPT TO
DEFRAUD A STATE HEALTH PLAN IN CONNECTION WITH THE DELIVERY OF OR
PAYMENT FOR HEALTH CARE SERVICES;
(2) WILLFULLY KNOWINGLY AND WILLFULLY OBTAIN OR ATTEMPT TO
OBTAIN BY MEANS OF A FALSE REPRESENTATION MONEY, PROPERTY, OR ANY THING
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- 4427 -
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