KRS § 205.8451 — KY Code / Title XVII / Chapter 205 / Section 205.8451
205.8451 Definitions for KRS 205.8451 to 205.8483
Status: in_force

205.8451 Definitions for KRS 205.8451 to 205.8483.

As used in KRS 205.8451 to 205.8483, unless the context otherwise requires:

(1) "Benefit" means the receipt of money, goods, or anything of pecuniary value from

the Medical Assistance Program.

(2) "Fraud" means an intentional deception or misrepresentation made by a recipient or

a provider with the knowledge that the deception could result in some unauthorized

benefit to the recipient or provider or to some other person. It includes any act that

constitutes fraud under applicable federal or state law.

(3) "Immediate family member" means a parent, grandparent, spouse, child, stepchild,

father-in-law, mother-in-law, son-in-law, daughter-in-law, sibling, brother-in-law,

sister-in-law, or grandchild.

(4) "Intentional" or "intentionally" means, with respect to a result or to conduct

described by a statute defining an offense, that a person's conscious objective is to

cause that result or to engage in that conduct.

(5) "Knowingly" means, with respect to conduct or to a circumstance described by a

statute defining an offense, that a person is aware that his conduct is of that nature

or that the circumstance exists.

(6) "Medical Assistance Program" means the program of medical assistance as

administered by the Cabinet for Health and Family Services in compliance with

Title XIX of the Federal Social Security Act and any administrative regulations

related thereto.

(7) "Provider" means an individual, company, corporation, association, facility, or

institution which is providing or has been approved to provide medical services,

goods, or assistance to recipients under the Medical Assistance Program.

(8) "Provider abuse" means, with reference to a health care provider, practices that are

inconsistent with sound fiscal, business, or medical practices, and that result in

unnecessary cost to the Medical Assistance Program established pursuant to this

chapter, or that result in reimbursement for services that are not medically necessary

or that fail to meet professionally recognized standards for health care. It also

includes practices that result in unnecessary cost to the Medical Assistance

Program.

(9) "Recipient" means any person receiving or who has received medical assistance

benefits.

(10) "Recipient abuse" means, with reference to a medical assistance recipient, practices

that result in unnecessary cost to the Medical Assistance Program or the obtaining

of goods, equipment, medicines, or services that are not medically necessary, or that

are excessive, or constitute flagrant overuse or misuse of Medical Assistance

Program benefits for which the recipient is covered.

(11) "Wantonly" means, with respect to a result or to a circumstance described by a

statute defining an offense, that a person is aware of and consciously disregards a

substantial and unjustifiable risk that the result will occur or that the circumstance

exists. The risk must be of such nature and degree that disregard thereof constitutes

a gross deviation from the standard of conduct that a reasonable person would

observe in the situation. A person who creates such a risk but is unaware thereof

solely by reason of voluntary intoxication also acts wantonly with respect thereto.