191.900. Definitions.

459 words·~2 min read·/mo/chapter-191/191-900

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191.900. Definitions. — As used in sections 191.900 to 191.910 , the following terms mean:

(1)"Abuse" , the infliction of physical, sexual or emotional harm or injury. "Abuse" includes the taking, obtaining, using, transferring, concealing, appropriating or taking possession of property of another person without such person's consent;

(2)"Claim" , any attempt to cause a health care payer to make a health care payment;

(3)"False" , wholly or partially untrue. A false statement or false representation of a material fact means the failure to reveal material facts in a manner which is intended to deceive a health care payer with respect to a claim;

(4)"Health care" , any service, assistance, care, product, device or thing provided pursuant to a medical assistance program, or for which payment is requested or received, in whole or part, pursuant to a medical assistance program;

(5)"Health care payer" , a medical assistance program, or any person reviewing, adjusting, approving or otherwise handling claims for health care on behalf of or in connection with a medical assistance program;

(6)"Health care payment" , a payment made, or the right under a medical assistance program to have a payment made, by a health care payer for a health care service;

(7)"Health care provider" , any person delivering, or purporting to deliver, any health care, and including any employee, agent or other representative of such a person, and further including any employee, representative, or subcontractor of the state of Missouri delivering, purporting to deliver, or arranging for the delivery of any health care;

(8)"Knowing" and "knowingly" , that a person, with respect to information:

(a)Has actual knowledge of the information;

(b)Acts in deliberate ignorance of the truth or falsity of the information; or

(c)Acts in reckless disregard of the truth or falsity of the information.

Use of the terms knowing or knowingly shall be construed to include the term "intentionally" , which means that a person, with respect to information, intended to act in violation of the law;

(9)"Medical assistance program" , MO HealthNet, or any program to provide or finance health care to participants which is established pursuant to title 42 of the United States Code, any successor federal health insurance program, or a waiver granted thereunder. A medical assistance program may be funded either solely by state funds or by state and federal funds jointly. The term "medical assistance program" shall include the medical assistance program provided by section 208.151 , et seq., and any state agency or agencies administering all or any part of such a program;

(10)"Person" , a natural person, corporation, partnership, association or any legal entity.

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(L. 1994 H.B. 1427 § 1, A.L. 2007 S.B. 577)