N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 521-2.2

Current through Register Vol. 46, No. 45, November 2, 2024

Section 521-2.2 - Definitions

(a) For purposes of this SubPart, the terms defined in Parts 504 and 515 of this Title, and SubPart 521-1 of this Part, unless noted otherwise, shall apply.

(b) In addition, for the purposes of this SubPart, the following terms have the following meanings:

(1) "Abuse" means practices that are inconsistent with sound fiscal, business, medical or professional practices, and which result in unnecessary costs to the Medicaid program, payments for services that were not medically necessary, or payments for services which fail to meet recognized standards for health care. It also includes enrollee practices that result in unnecessary costs to the Medicaid program.

(2) "Fraud" means an intentional deception or misrepresentation made with the knowledge that the deception could result in some unauthorized benefit to the provider, Contractor, Subcontractor, or another person and includes the acts prohibited by section 366-b of the Social Services Law. It also includes any other act that constitutes fraud under applicable Federal or State law.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 521-2.2

Adopted New York State Register December 28, 2022/Volume XLIV, Issue 52, eff. 12/28/2022