Common use of Medicaid Fraud Control Clause in Contracts

Medicaid Fraud Control. Unit (MFCU) means the statutorily authorized criminal investigation unit in the Utah Attorney General’s Office charged with investigating and prosecuting Medicaid Fraud. Medicaid Information Bulletin (MIB) means the official, periodic publication of the Division of Medicaid and Health Financing to update the Utah Medicaid Provider Manual or issue information to Medicaid providers. Medical Loss Ratio (MLR) means a measure of the percentage of premium dollars that a health plans spends on medical claims and quality improvements, versus administrative costs. MLR is described in Article 12.5. Medically Necessary or Medical Necessity means needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine. Member Services means a method of assisting Enrollees in understanding Contractor policies and procedures, facilitating referrals to participating specialists, and assisting in the resolution of problems and member complaints. The purpose of Member Services is to improve access to services and promote Enrollee satisfaction. National Committee for Quality Assurance (NCQA) means a private, non-profit organization dedicated to improving health care quality by evaluating and reporting on the quality of managed care and other health care organizations in the United States. NCQA developed HEDIS and maintains and updates a database of HEDIS results.