(a) As used in this chapter the following terms have the meaning set forth in this section, unless the context requires otherwise:(a) “Claim” means any application for payment made by any provider from the Virgin Islands Medicaid Program, or its fiscal agents, for each good or service purported by the provider to have been provided by the provider to any Medicaid recipient.A claim includes any communication, including written, electronic, or magnetic:(1) which is used to identify a good, item, or service as reimbursable pursuant to the Virgin Islands Medicaid Program; or(2) which states income or expense and is or may be used to determine a rate of payment pursuant to the Virgin Islands Medicaid Program.(b) “Fiscal agent” means any individual, firm, corporation, professional association, partnership, organization, or other legal entity which, through a contractual relationship with the Virgin Islands Department of Human Services, receives, processes, and pays claims under the Virgin Islands Medicaid Program.(c) “Medicaid fraud” means the commission of any of the actions described in § 686 of this chapter.(d) “Participant” means any person who has applied to participate or who participates in the Virgin Islands Medicaid Program as a supplier of goods or services.(e) “Person” means an individual or an entity.(f) “Provider” means any participant or any employee of a participant, whether that participant is an individual, individual medical vendor, firm, corporation, professional association, partnership, organization, or other legal entity under the Virgin Islands Medicaid Program; or any individual, individual medical vendor, firm, corporation, professional association, partnership, organization, other legal entity, or any employee thereof who is not a participant under the Virgin Islands Medicaid Program but who provides goods or services to a participant under the Virgin Islands Medicaid Program for which the provider submits claims to the Virgin Islands Medicaid Program or its fiscal agents.(g) “Recipient” means any individual on whose behalf any provider claimed or received any payment or payments from the Virgin Islands Medicaid Program or its fiscal agents, whether or not, any such individual was eligible for benefits under the Virgin Islands Medicaid Program.(h) “Records” means all medical, professional, or business records or documents relating to the treatment or care of any Medicaid recipient, or to goods or services provided to any such recipient, or to rates or amounts paid or claimed for such goods or services, including, but not limited to records of non-Medicaid goods or services, to verify rates or amounts; and any provider records required to be kept by the Virgin Islands Department of Human Services.(i) “Sign” means to affix a signature directly or indirectly by means of handwriting, typewriter, signature stamp, computer impulse, or other means recognized by Virgin Islands law.(j) “Virgin Islands Medicaid Program” means the territorial program administered by the Virgin Islands Department of Human Services pursuant to Title XIX of the Social Security Act which provides for payments for medical goods or services on behalf of indigent families with dependent children and on behalf of aged, blind, or disabled individuals whose income and resources are insufficient to meet the cost of necessary medical services.
(a) “Claim” means any application for payment made by any provider from the Virgin Islands Medicaid Program, or its fiscal agents, for each good or service purported by the provider to have been provided by the provider to any Medicaid recipient.
(1) A claim includes any communication, including written, electronic, or magnetic:(1) which is used to identify a good, item, or service as reimbursable pursuant to the Virgin Islands Medicaid Program; or(2) which states income or expense and is or may be used to determine a rate of payment pursuant to the Virgin Islands Medicaid Program.
(1) which is used to identify a good, item, or service as reimbursable pursuant to the Virgin Islands Medicaid Program; or
(2) which states income or expense and is or may be used to determine a rate of payment pursuant to the Virgin Islands Medicaid Program.
(b) “Fiscal agent” means any individual, firm, corporation, professional association, partnership, organization, or other legal entity which, through a contractual relationship with the Virgin Islands Department of Human Services, receives, processes, and pays claims under the Virgin Islands Medicaid Program.
(c) “Medicaid fraud” means the commission of any of the actions described in § 686 of this chapter.
(d) “Participant” means any person who has applied to participate or who participates in the Virgin Islands Medicaid Program as a supplier of goods or services.
(e) “Person” means an individual or an entity.
(f) “Provider” means any participant or any employee of a participant, whether that participant is an individual, individual medical vendor, firm, corporation, professional association, partnership, organization, or other legal entity under the Virgin Islands Medicaid Program; or any individual, individual medical vendor, firm, corporation, professional association, partnership, organization, other legal entity, or any employee thereof who is not a participant under the Virgin Islands Medicaid Program but who provides goods or services to a participant under the Virgin Islands Medicaid Program for which the provider submits claims to the Virgin Islands Medicaid Program or its fiscal agents.
(g) “Recipient” means any individual on whose behalf any provider claimed or received any payment or payments from the Virgin Islands Medicaid Program or its fiscal agents, whether or not, any such individual was eligible for benefits under the Virgin Islands Medicaid Program.
(h) “Records” means all medical, professional, or business records or documents relating to the treatment or care of any Medicaid recipient, or to goods or services provided to any such recipient, or to rates or amounts paid or claimed for such goods or services, including, but not limited to records of non-Medicaid goods or services, to verify rates or amounts; and any provider records required to be kept by the Virgin Islands Department of Human Services.
(i) “Sign” means to affix a signature directly or indirectly by means of handwriting, typewriter, signature stamp, computer impulse, or other means recognized by Virgin Islands law.
(j) “Virgin Islands Medicaid Program” means the territorial program administered by the Virgin Islands Department of Human Services pursuant to Title XIX of the Social Security Act which provides for payments for medical goods or services on behalf of indigent families with dependent children and on behalf of aged, blind, or disabled individuals whose income and resources are insufficient to meet the cost of necessary medical services.