Arkansas Code Title 20. Public Health and Welfare § 20-77-2502. Definitions

(1)(A) “Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.

(B) “Abuse” includes recipient practices that result in an unnecessary cost to the Medicaid program;

(2)(A) “Fraud” means a purposeful deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to the person or another person.

(B) “Fraud” includes any act that constitutes fraud under applicable federal or state law;

(A) Health insurance plans;

(B) Managed care organization plans;

(C) Risk-based provider plans;

(D) The Arkansas Medicaid Program;

(E) The Social Security Disability Insurance program; and

(F) The Medicare program;

(A) Reducing other payments currently owed to the provider;

(B) Withholding or setting off the amount against current or future payments to the provider;

(C) Demanding payment back from a provider for a claim already paid; or

(D) Reducing or affecting in any other manner the future claim payments to the provider; and