21-3845. Definitions. - Kansas Statutes

21-3845

Chapter 21.--CRIMES AND PUNISHMENTS PART II.--PROHIBITED CONDUCT Article 38.--CRIMES AFFECTING GOVERNMENTAL FUNCTIONS

      21-3845.   Definitions.As used in this act:

      (a)   "Attorney general" means the attorney general, employees of theattorney general or authorized representatives of the attorney general.

      (b)   "Benefit" means the receipt of money, goods, items, facilities,accommodations or anything of pecuniary value.

      (c)   "Claim" means an electronic, electronic impulse, facsimile, magnetic,oral, telephonic or written communication that is utilized to identify anygoods, service, item, facility or accommodation as reimbursable to the Kansasmedicaid program, or its fiscal agents, or which states income or expense andis or may be used to determine a rate of payment by the Kansas medicaidprogram, or its fiscal agent.

      (d)   "Fiscal agent" means any corporation, firm, individual, organization,partnership, professional association or other legal entity which, through acontractual relationship with the department of social andrehabilitation services and thereby, the state of Kansas, receives, processesand pays claims under the Kansas medicaid program.

      (e)   "Family member" means spouse, child, grandchild of any degree,parent, mother-in-law, father-in-law, grandparent of any degree, brother,brother-in-law, sister, sister-in-law, half-brother, half-sister,uncle, aunt, nephew or niece, whether biological, step or adoptive.

      (f)   "Medicaid program" means the Kansas program of medical assistance forwhich federal or state moneys, or any combination thereof, are expendedas administered by thedepartment of social and rehabilitation services, or its fiscal agent,or any successor federal or state, or both, health insurance program or waivergranted thereunder.

      (g)   "Medically necessary" means for the purposes of this act only, anygoods,service, item, facility, or accommodation, that a reasonable and prudentprovider under similar circumstances would believe is appropriate fordiagnosing or treating a recipient's condition, illness or injury.

      (h)   "Person" means any agency, association, corporation, firm, limitedliability company, limited liability partnership, natural person, organization,partnership or other legal entity, the agents, employees, independentcontractors, and subcontractors, thereof, and the legal successors thereto, andany official, employee or agent of a state or federal agency having regulatoryor administrative authority over the medicaid program.

      (i)   "Provider" means a person who has applied to participate in, whocurrently participates in, who has previously participated in, who attempts orhas attempted to participate in the medicaid program, by providing orclaiming to have provided goods, services, items, facilities oraccommodations.

      (j)   "Recipient" means an individual, either real or fictitious, in whosebehalf any person claimed or received any payment or payments from themedicaid program, or its fiscal agent, whether or not any such individual waseligible for benefits under the medicaid program.

      (k)   "Records" mean all written documents and electronic or magneticdata, including, but not limited to, medical records, X-rays, professional,financial or business records relating to the treatment or care of anyrecipient; goods, services, items, facilities or accommodations provided toany such recipient; rates paid for such goods, services, items, facilities oraccommodations; and goods, services, items, facilities, or accommodationsprovided to nonmedicaid recipients to verify rates or amounts of goods,services, items,facilities or accommodations provided to medicaid recipients, as well as anyrecords that the medicaid program, or its fiscal agents requireproviders to maintain.

      (l)   "Sign" means to affix a signature, directly or indirectly, by meansof handwriting, typewriter, stamp, computer impulse or other means.

      (m)   "Statement or representation" means an electronic, electronicimpulse, facsimile, magnetic, oral, telephonic, or written communication thatisutilized to identify any goods, service, item, facility or accommodation asreimbursable to the medicaid program, or its fiscal agent, or thatstates income or expense and is or may be used to determine a rate of paymentby the medicaid program, or its fiscal agent.

      History:   L. 1996, ch. 267, § 2; July 1.