2023 Colorado Revised Statutes › Title 24 - GOVERNMENT - STATE (§§ 24-1-101 — 24-116-102) › PRINCIPAL DEPARTMENTS (§§ 24-30-101 — 24-36-306) › Article 31 - DEPARTMENT OF LAW (§§ 24-31-101 — 24-31-1303) › Part 8 - MEDICAID FRAUD CONTROL (§§ 24-31-801 — 24-31-811) › Section 24-31-801 - Definitions

As used in this part 8, unless the context otherwise requires:
(1)
"Abuse" means willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical or financial harm or pain or mental anguish, including any acts or omissions that constitute a criminal violation under state law.
(2)
"Beneficiary" means any individual who receives goods or services from a provider under the medicaid program.
(3)
"Benefit" means any benefit authorized under the "Colorado Medical Assistance Act".
(4)
"Claim" means any communication submitted to the medicaid program or to a person that has contracted with the medicaid program, whether oral, written, electronic, or magnetic, that identifies a good, item, or service as reimbursable under the medicaid program; is used to authorize the provision of services under the medicaid program; serves as an invoice for services provided under contract with the medicaid program; or states income or expense and is or may be used to determine a rate of payment under the medicaid program.
(5)
"Colorado Medical Assistance Act" means articles
4
to
6
of title
25.5
.
(6)
"Exploitation" means the wrongful taking or use of funds or property of a patient residing in a health-care facility or board and care facility that constitutes a criminal violation under state law.
(7)
"Knowingly" and "willfully" have the same meaning as set forth in section
18-1-501 (6)
.
(8)
"Material information" means an assertion or information directly pertaining to a claim, record, statement, or representation that a reasonable person knows or should know will affect the action, conduct, or decision of the person who receives or is intended to receive the asserted information in a manner that would directly or indirectly benefit the person making the assertion.
(9)
"Medicaid fraud and waste" means any act, by commission or omission, as described in section
24-31-808
.
(10)
"Medicaid program" means the medical assistance program authorized by Title XIX of the federal "Social Security Act" and implemented by the "Colorado Medical Assistance Act".
(11)
"Neglect" means willful failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness, including any neglect that constitutes a criminal violation under state law.
(12)
"Person" means an individual, public or private institution, corporation, partnership, association, or managed care entity.
(13)
"Provider" means any person, employee, agent, representative, contractor, or subcontractor of a person:
(a)
Who has entered into a provider agreement with the department of health care policy and financing to provide goods or services pursuant to the medicaid program;
(b)
Who has entered into an agreement with a party to such a provider agreement under which the person agrees to provide goods or services that are reimbursable under the medicaid program;
(c)
Who is reimbursed or receives compensation for delivering, purporting to deliver, or arranging for the delivery of health-care goods or services from the medicaid program;
(d)
Who is defined as such in section
25.5-4-103 (19)
; or
(e)
Who is defined as such in section
25.5-4-416 (1)
.
(14)
"Records" means any medical, professional, or business records relating to the treatment or care of any beneficiary, to goods or services provided to any beneficiary, or to rates paid for goods or services provided to any beneficiary and any records that are required to be kept by the rules of the medicaid program.
(15)
"Statement or representation" means any oral, written, or electronic communication that is used to identify an item of goods or a service for which reimbursement may be made under the medicaid program or that states income and expense and is or may be used to determine a rate of reimbursement under the medicaid program, that may serve as the basis for the calculation of a payment to a provider, or that may serve as a basis for receiving payment.
(16)
"Unit" means the medicaid fraud control unit created in section
24-31-802
.
Added by 2018 Ch. 159, § 2, eff. 1/1/2019.
L. 2018: Entire part added, (HB 18-1211), ch. 159, p. 1113, § 2, effective 1/1/2019.