Fraud. any intentional deception made for personal gain or to damage another individual, group, or entity. It includes any act that constitutes fraud under applicable federal or state law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 27 contracts
Sources: Pace Contract, Contract, Contract
Fraud. any The intentional deception or misrepresentation made for personal gain by a person with the knowledge that the deception could result in some unauthorized benefit to himself or to damage another individual, group, or entitysome other person. It includes any act that constitutes fraud under applicable federal Federal or state State law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 13 contracts
Sources: Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco), Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco), Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco)
Fraud. any An intentional deception or misrepresentation made for personal gain by a person or entity with the knowledge that the deception could result in some unauthorized benefit to damage another individualhim/herself, group, itself or some other person or entity. It includes any act that constitutes fraud under applicable federal or state law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 10 contracts
Sources: Contract for Services, Hmo Services Agreement, Contract for Badgercare Plus and/or Medicaid Ssi Hmo Services
Fraud. any An intentional deception or misrepresentation made for personal by a person with the knowledge that the deception could result in some unauthorized benefit or financial gain to him/herself or to damage another individual, group, or entitysome other person. It includes any act that constitutes fraud Fraud under applicable federal or state State law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 7 contracts
Sources: Contract for External Quality Review Services, Contract for Provision of Services (Wellcare Health Plans, Inc.), Contract for Provision of Services (Amerigroup Corp)
Fraud. any An intentional deception or misrepresentation made for personal gain by a person with the knowledge that the deception results in unauthorized benefit to that person or to damage another individual, group, or entityperson. It The term includes any act that constitutes fraud under applicable federal or state law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 6 contracts
Sources: Dental Medicaid Care Management Agreement, Standard Contract (Wellcare Health Plans, Inc.), Standard Contract (Wellcare Health Plans, Inc.)
Fraud. any An intentional deception or misrepresentation made for personal gain by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or to damage another individual, group, or entitysome other person. It includes any act that constitutes fraud under applicable federal or state law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain law (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347see 42 CFR 455.2).
Appears in 5 contracts
Sources: Tenncare Program Regulatory Requirements Appendix, Provider Agreement, Provider Agreement
Fraud. any An intentional deception or misrepresentation made for personal gain by a person with the knowledge that the deception results in unauthorized benefit to herself or to damage himself or another individual, group, or entityperson. It The term includes any act that constitutes fraud under applicable federal or state law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 4 contracts
Sources: Health Care Services Contract (Wellcare Health Plans, Inc.), Health Care Services Contract (Wellcare Health Plans, Inc.), Health Care Services Agreement
Fraud. any The intentional deception or misrepresentation made for personal gain by a person or entity with the knowledge that the deception could result in some unauthorized benefit to damage another individual, group, the person or entity or some other person or entity. It includes any act that constitutes fraud under applicable federal Federal or state State law. Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347).
Appears in 3 contracts
Sources: Contractual Agreement, Contractual Agreement, Contractual Agreement
Fraud. any Any type of intentional deception made for personal gain or to damage another individualmisrepresentation, group, or entity. It includes including any act that constitutes fraud under applicable federal Federal or state law. Fraud is knowingly and willfully executingState Law, made by an entity or person with the knowledge that the deception could result in some unauthorized benefit to the entity or person, or attempting to execute, some other person in a scheme or artifice to defraud any health managed care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347)setting.
Appears in 3 contracts
Sources: Healthchoices Behavioral Health Agreement, Healthchoices Behavioral Health Program Standards and Requirements, Healthchoices Behavioral Health Program Standards and Requirements
Fraud. any Any intentional deception or misrepresentation made for personal gain by an individual or entity with the knowledge that the deception could result in some unauthorized benefit to damage another the individual, groupthe entity, or entitysome other person. It This includes any act that constitutes fraud Fraud under applicable federal or state State law. Beneficiary Fraud is knowingly and willfully executing, means the altering of information or attempting documents in order to execute, a scheme or artifice to defraud any health care benefit program fraudulently receive unauthorized benefits or to knowingly permit others to use the Beneficiary’s identification card to obtain (by means of false services or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347)supplies.
Appears in 2 contracts
Fraud. any An intentional deception made for personal gain or misrepresentation by a person or an entity with the knowledge that the deception could result in some unauthorized benefit to damage another individual, group, himself or entitysome other person. It includes any act that constitutes fraud under applicable federal or state law, consistent with NMAC 8.305.13.10. Fraud is knowingly and willfully executing[See, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program (18 U.S.C. 1347)NMAC 8.305.1.7.]
Appears in 1 contract