2019 Mississippi Code
Title 7 - Executive Department
Chapter 5 - Attorney General
Insurance Integrity Enforcement Bureau
§ 7-5-303. Definitions; prohibited activities

Universal Citation: MS Code § 7-5-303 (2019)
  • (1) As used in this section:

    • (a) “An insurance plan” means a plan or program that provides health benefits whether directly through insurance or otherwise and includes a policy of life or property and casualty insurance, a contract of a service benefit organization, workers’ compensation insurance or any program or plan implemented in accordance with state law or a membership agreement with a health maintenance organization or other prepaid programs.

    • (b) “Insurance official” means:

      • (i) An administrator, officer, trustee, fiduciary, custodian, counsel, agent or employee of any insurance plan;

      • (ii) An officer, counsel, agency or employee of an organization, corporation, partnership, limited partnership or other entity that provides, proposes to, or contracts to provide services through any insurance plan; or

      • (iii) An official, employee or agent of a state or federal agency having regulatory or administrative authority over any insurance plan.

  • (2) A person or entity shall not, with the intent to appropriate to himself or to another any benefit, knowingly execute, collude or conspire to execute or attempt to execute a scheme or artifice:

    • (a) To defraud any insurance plan in connection with the delivery of, or payment for, insurance benefits, items, services or claims; or

    • (b) To obtain by means of false or fraudulent pretense, representation, statement or promise money, or anything of value, in connection with the delivery of or payment for insurance claims under any plan or program or state law, items or services which are in whole or in part paid for, reimbursed, subsidized by, or are a required benefit of, an insurance plan or an insurance company or any other provider.

  • (3) A person or entity shall not directly or indirectly give, offer or promise anything of value to an insurance official, or offer or promise an insurance official to give anything of value to another person, with intent to influence such official’s decision in carrying out any of his duties or laws or regulations.

  • (4) Except as otherwise allowed by law, a person or entity shall not knowingly pay, offer, deliver, receive, solicit or accept any remuneration, as an inducement for referring or for refraining from referring a patient, client, customer or service in connection with an insurance plan.

  • (5) A person or entity shall not, in any matter related to any insurance plan, knowingly and willfully falsify, conceal or omit by any trick, scheme, artifice or device a material fact, make any false, fictitious or fraudulent statement or representation or make or use any false writing or document, knowing or having reason to know that the writing or document contains any false or fraudulent statement or entry in connection with the provision of insurance programs.

  • (6) A person or entity shall not fraudulently deny the payment of an insurance claim.

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