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Contract Type FiledNovember 16th, 2015Abuse — Any practices that are inconsistent with sound fiscal, business, or medical practices, and result in unnecessary costs to the Medical Assistance Program, or in reimbursement for services that are not Medically Necessary or that fail to meet professionally recognized standards or agreement obligations (including the RFP, agreement, and the requirements of state or federal regulations) for healthcare in a managed care setting. The Abuse can be committed by the CHC-MCO, subcontractor, Provider, State employee, or a Participant, among others. Abuse also includes Participant practices that result in unnecessary cost to the Medical Assistance Program, the CHC-MCO, a subcontractor, or Provider.