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Abuse is defined by Federal law (42
CFR 455.2) as "provider practices that are inconsistent with sound fiscal,
business, or medical practices, and result in an unnecessary cost to the Medicaid
program, or in reimbursement for services that are not medically necessary or fail
to meet professionally recognized standards for health care. It also includes recipient
practices that result in unnecessary cost to the Medicaid program."
Abuse of a member, as defined by Arizona law (A.R.S. 46-451 &
13-3623), means any intentional, knowing or reckless infliction of physical
harm, injury caused by negligent acts or omissions, unreasonable confinement, emotional
or sexual abuse, or sexual assault.