Common use of Medicaid Fraud Control Clause in Contracts

Medicaid Fraud Control. Unit (MFCU) means the statutorily authorized criminal investigation unit charged with investigating and prosecuting the Medicaid and CHIP fraud in the Utah Attorney General’s Office. Medically Necessary or Medical Necessity means any medical service that is (1) reasonably calculated to prevent, diagnose, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause deformity or malfunction, or threaten to cause a handicap; and (2) there is no equally effective course of treatment available or suitable for the Enrollee requesting the service which is more conservative or substantially less costly. To be considered Medically Necessary, the medical services shall be of a quality that meets professionally recognized standards of dental care, and shall be substantiated by records including evidence of such medical necessity and quality. Those records will be made available to the Department upon request.

Medicaid Fraud Control. Unit (MFCU) means the statutorily authorized criminal investigation unit charged with investigating and prosecuting the Medicaid and CHIP fraud in the Utah Attorney General’s Office. Medically Necessary or Medical Necessity means any medical service that is (1) reasonably calculated to prevent, diagnose, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause deformity or malfunction, or threaten to cause a handicap; and (2) there is no equally effective course of treatment available or suitable for the Enrollee requesting the service which is more conservative or substantially less costly. To be considered Medically Necessary, the medical services shall be of a quality that meets professionally recognized standards of dental health care, and shall be substantiated by records including evidence of such medical necessity and quality. Those records will be made available to the Department upon request.