2020 Colorado Revised Statutes
Title 24 - Government - State
Article 31. Department of Law
Section 24-31-801. Definitions.

As used in this part 8, unless the context otherwise requires:

  1. "Abuse" means willful infliction of injury, unreasonable confinement, intimidation,or punishment with resulting physical or financial harm or pain or mental anguish, including any acts or omissions that constitute a criminal violation under state law.

  2. "Beneficiary" means any individual who receives goods or services from a providerunder the medicaid program.

  3. "Benefit" means any benefit authorized under the "Colorado Medical Assistance Act".

  4. "Claim" means any communication submitted to the medicaid program or to a personthat has contracted with the medicaid program, whether oral, written, electronic, or magnetic, that identifies a good, item, or service as reimbursable under the medicaid program; is used to authorize the provision of services under the medicaid program; serves as an invoice for services provided under contract with the medicaid program; or states income or expense and is or may be used to determine a rate of payment under the medicaid program.

  5. "Colorado Medical Assistance Act" means articles 4 to 6 of title 25.5.

  6. "Exploitation" means the wrongful taking or use of funds or property of a patientresiding in a health care facility or board and care facility that constitutes a criminal violation under state law.

  7. "Knowingly" and "willfully" have the same meaning as set forth in section 18-1-501 (6).

  8. "Material information" means an assertion or information directly pertaining to aclaim, record, statement, or representation that a reasonable person knows or should know will affect the action, conduct, or decision of the person who receives or is intended to receive the asserted information in a manner that would directly or indirectly benefit the person making the assertion.

  9. "Medicaid fraud and waste" means any act, by commission or omission, as describedin section 24-31-808.

  10. "Medicaid program" means the medical assistance program authorized by Title XIXof the federal "Social Security Act" and implemented by the "Colorado Medical Assistance Act".

  11. "Neglect" means willful failure to provide goods and services necessary to avoidphysical harm, mental anguish, or mental illness, including any neglect that constitutes a criminal violation under state law.

  12. "Person" means an individual, public or private institution, corporation, partnership,association, or managed care entity.

  13. "Provider" means any person, employee, agent, representative, contractor, or subcontractor of a person:

  1. Who has entered into a provider agreement with the department of health care policyand financing to provide goods or services pursuant to the medicaid program;

  2. Who has entered into an agreement with a party to such a provider agreement underwhich the person agrees to provide goods or services that are reimbursable under the medicaid program;

  3. Who is reimbursed or receives compensation for delivering, purporting to deliver, orarranging for the delivery of health care goods or services from the medicaid program; (d) Who is defined as such in section 25.5-4-103 (19); or (e) Who is defined as such in section 25.5-4-416 (1).

  1. "Records" means any medical, professional, or business records relating to the treatment or care of any beneficiary, to goods or services provided to any beneficiary, or to rates paid for goods or services provided to any beneficiary and any records that are required to be kept by the rules of the medicaid program.

  2. "Statement or representation" means any oral, written, or electronic communicationthat is used to identify an item of goods or a service for which reimbursement may be made under the medicaid program or that states income and expense and is or may be used to determine a rate of reimbursement under the medicaid program, that may serve as the basis for the calculation of a payment to a provider, or that may serve as a basis for receiving payment.

  3. "Unit" means the medicaid fraud control unit created in section 24-31-802.

Source: L. 2018: Entire part added, (HB 18-1211), ch. 159, p. 1113, § 2, effective January 1, 2019.

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