Oklahoma § 56-1002 - Definitions

§ 56-1002. Definitions

As used in the Oklahoma Medicaid Program Integrity Act:

1. "Authority" means the Oklahoma Health Care Authority;

2. "Attorney General" means the Attorney General of this state,

his employees or his authorized representatives;

3. "Claim" means a communication, including written,

electronic, or magnetic, which is utilized to identify a good, item,

or service as reimbursable pursuant to the Oklahoma Medicaid

Program, or which states income or expense and is or may be used to

determine a rate of payment pursuant to the Oklahoma Medicaid

Program; and any application for payment by any person from the

Oklahoma Medicaid Program or its fiscal agents for each good or

service purported by any person to have been provided by any person

to any Medicaid recipient;

4. "Fiscal agents" means any individual, firm, corporation,

professional association, partnership, organization, or other legal

entity which, through a contractual relationship with the Oklahoma

Health Care Authority and, thereby, the State of Oklahoma, receives,

processes, and pays claims under the Oklahoma Medicaid Program;

5. "Kickback" means a return in any form by any individual,

company, corporation, partnership, or association of a part of an

expenditure made by a provider:

a.

to the same provider,

b.

to an entity controlled by the provider or,

c.

to an entity which the provider intends to benefit

whenever such expenditure is reimbursed, or

reimbursable, or claimed by a provider as being

reimbursable by the Oklahoma Medicaid Program and when

the sum or value returned is not credited to the

benefit of the Oklahoma Medicaid Program;

6. "Medicaid recipient" means any individual in whose behalf

any person claimed or received any payment or payments from the

Oklahoma Medicaid Program or its fiscal agents, whether or not any

such individual was eligible for benefits under the Oklahoma

Medicaid Program;

Oklahoma Statutes - Title 56. Poor Persons

7. "Oklahoma Medicaid Program" means the state program

administered by the Oklahoma Health Care Authority pursuant to Title

XIX of the federal Social Security Act, which provides for payments

for medical goods or services on behalf of indigent families with

dependent children and of aged, blind, or disabled individuals whose

income and resources are insufficient to meet the cost of necessary

medical services;

8. "Person" means any Medicaid provider of goods or services or

any employee of such provider, whether that provider is an

individual, individual medical vendor, firm, corporation,

professional association, partnership, organization, or other legal

entity under the Oklahoma Medicaid Program, or any individual,

individual medical vendor, firm, corporation, professional

association, partnership, organization, other legal entity, or any

employee of such who is not a provider under the Oklahoma Medicaid

Program but who provides goods or services to a provider under the

Oklahoma Medicaid Program for which the provider submits claims to

the Oklahoma Medicaid Program or its fiscal agents;

9. "Provider" means any person who has applied to participate

or who participates in the Oklahoma Medicaid Program as a supplier

of a good or a service;

10. "Records" means all medical, professional, or business records

or documents relating to the treatment or care of any recipient, or

to a good or a service provided to any such recipient, or to rates

or amounts paid or claimed for such a good or a service including

but not limited to records of non-Medicaid goods or services to

verify rates or amounts; and any records required to be kept by the

Oklahoma Health Care Authority to be kept by any person; and

11. "Sign" means to affix a signature directly or indirectly by

means of handwriting, typewriter, signature stamp, computer impulse,

or other means recognized by Oklahoma Law.

Added by Laws 1989, c. 220, § 2, operative July 1, 1989. Amended by

Laws 1990, c. 144, § 1, emerg. eff. May 1, 1990; Laws 1995, c. 306,

§ 1, eff. July 1, 1995.