Medicaid
RULE NO.: RULE TITLE:
59G-1.010 Definitions
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 31, No. 49, December 9, 2005, issue of the Florida Administrative Weekly. These changes are in response to written comments received from the Joint Administrative Procedures Committee.
59G-1.010 Definitions.
(1) “Abuse” is as defined in section 409.913(1)(a), F.S. means provider practices that are inconsistent with sound fiscal, business, or professional practices and result in an unnecessary cost to the Medicaid program, or in reimbursement for medical or allied care, goods, or services that are not medically necessary or that fail to meet professionally recognized standards for health care. It includes any unintentional violation of federal or state laws, regulations, rules, policies, directives or agreements relating to the Medicaid program. It also includes, or misutilization, whether intentional or inadvertent, including inappropriate prescribing, dispensing, or otherwise furnishing drugs or other medical or allied care, goods, or services by a provider. It also includes recipient practices that result in unnecessary cost to the Medicaid program.
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