Code of Federal Regulations (alpha)

CFR /  Title 42  /  Part 1007  /  Sec. 1007.1 Definitions.

As used in this part, unless otherwise indicated by the context:

Data mining is defined as the practice of electronically sorting Medicaid or other relevant data, including but not limited to the use of statistical models and intelligent technologies, to uncover patterns and relationships within that data to identify aberrant utilization, billing, or other practices that are potentially fraudulent.

Employ or employee, as the context requires, means full-time duty intended to last at least a year. It includes an arrangement whereby an individual is on full-time detail or assignment to the unit from another government agency, if the detail or assignment is for a period of at least 1 year and involves supervision by the unit.

Provider means an individual or entity that furnishes items or services for which payment is claimed under Medicaid.

Unit means the State Medicaid fraud control unit. [57 FR 3355, Jan. 29, 1992, as amended at 78 FR 29061, May 17, 2013]