205.8451 Definitions for KRS 205.8451 to 205.8483.
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<![CDATA[ Page 1 of 2 205.8451 Definitions for KRS 205.8451 to 205.8483. As used in KRS 205.8451 to 205.8483, unless the context otherwise requires: <br>(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 <br>benefit to the recipient or provider or to some other person. It includes any act that <br>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, <br>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 <br>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 <br>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 <br>Title XIX of the Federal Social Security Act and any administrative regulations <br>related thereto. (7) "Provider" means an individual, company, corporation, association, facility, or institution which is providing or has been approved to provide medical services, <br>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 <br>unnecessary cost to the Medical Assistance Program established pursuant to this <br>chapter, or that result in reimbursement for services that are not medically necessary <br>or that fail to meet professionally recognized standards for health care. It also <br>includes practices that result in unnecessary cost to the Medical Assistance <br>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 <br>of goods, equipment, medicines, or services that are not medically necessary, or that <br>are excessive, or constitute flagrant overuse or misuse of Medical Assistance <br>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 <br>substantial and unjustifiable risk that the result will occur or that the circumstance <br>exists. The risk must be of such nature and degree that disregard thereof constitutes <br>a gross deviation from the standard of conduct that a reasonable person would Page 2 of 2 observe in the situation. A person who creates such a risk but is unaware thereof <br>solely by reason of voluntary intoxication also acts wantonly with respect thereto. Effective: June 20, 2005 <br>History: Amended 2005 Ky. Acts ch. 99, sec. 275, effective June 20, 2005. -- Amended 1998 Ky. Acts ch. 426, sec. 222, effective July 15, 1998. -- Created 1994 Ky. Acts <br>ch. 96, sec. 1, effective July 15, 1994; and ch. 316, sec. 1, effective July 15, 1994. ]]>