UJI 14-4401. Definitions for medicaid fraud instructions.

“Benefit” means money, treatment, services, goods or anything of value authorized under the program. “Claim” means any communication, whether oral, written, electronic or magnetic, that identifies a treatment, good or service as reimbursable under the program. “Department” means the human services department. “Health care official” means 1) an administrator, officer, trustee, fiduciary, custodian, counsel agent or employee of a managed care health plan; 2) an officer, counsel, agent or employee of an organization that provides, proposes to or contracts to provide services to a managed health care plan; or 3) an official, employee or agent of a state or federal agency with regulatory or administrative authority over a managed health care plan. “Managed health care plan” means a government-sponsored health benefit plan that requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by a health care insurer or provider service network. A “managed health care plan” includes the health care services offered by a health maintenance organization, preferred provider organization, health care insurer, provider service network, entity or person that contracts to provide or provides goods or services that are reimbursed by or are a required benefit of a state or federally funded health benefit program, or any person or entity who contracts to provide goods or services to the program. “Program” means the medical assistance program authorized under Title XIX of the federal Social Security Act, 42 U.S.C. § 1396, et seq., and implemented under Section 27-2-12, NMSA 1978. “Provider” means any person who has applied to participate or who participates in the program as a supplier of treatment, services or goods. “Recipient” means any individual who receives or requests benefits under the program. “Records” means any medical or business documentation, however recorded, relating to the treatment or care of any recipient, to services or goods provided to any recipient or to reimbursement for treatment, services or goods, including any documentation required to be retained by regulations of the program.