(4) “Division” means the Division of Medicaid and Health Financing, created in Section 26-18-2.1.
(5) “Extrapolation” means a method of using a mathematical formula that takes the audit results from a small sample of Medicaid claims and projects those results over a much larger group of Medicaid claims.
(6) “Fraud” means intentional or knowing:
(a) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, a claim, reimbursement, or services; or
(b) a violation of a provision of Sections 26-20-3 through 26-20-7.
(7) “Fraud unit” means the Medicaid Fraud Control Unit of the attorney general’s office.
(8) “Health care professional” means a person licensed under:
(b) billing or recordkeeping services relating to Medicaid funds.
(12) “Upcoding” means assigning an inaccurate billing code for a service that is payable or reimbursable by Medicaid funds, if the correct billing code for the service, taking into account reasonable opinions derived from official published coding definitions, would result in a lower Medicaid payment or reimbursement.
(a) “Waste” means the act of using or expending a resource carelessly, extravagantly, or to no purpose.
(b) “Waste” includes an activity that:
(i) does not constitute abuse or necessarily involve a violation of law; and