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Medical Fraud Control Units (MFCU)

A statewide program by the U.S. Department of Health and Human Services that focuses on the investigation and prosecution of health care providers that defraud the Medicare program.

Medical Home

Patients receive primary care services, an ongoing relationship with a primary care provider, and enhanced access to nonemergent primary, secondary and tertiary care in this health care setting.

Medical Imaging

The technique and process used to create images of the human body for clinical purposes or medical science.

Medical IRA

A personal financial account that allows individuals to save money for health care services and offers a variety of tax benefits.

Medical Loss Ratio (MLR)

The percentage of health insurance premium dollars an insurer spends on reimbursement for clinical services and activities to improve health care quality. The Affordable Care Act sets minimum MLRs for different state markets; companies are required to issue rebates to consumers if too large a share of the expenditures are allocated to administrative costs not directly associated with care (maximum of 15 percent for large group plans and a maximum of 20 percent for individual or small group plans).

Medical Malpractice Grants

Grants offered to states as a part of an initiative to update current tort litigation practices.

Medical Necessity

Accepted health care services or supplies provided by health care entities, appropriate to the evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care.

Medical Underwriting

Determining acceptance of an applicant for health care insurance based on their medical history. It also determines the terms of the coverage including premium cost and pre-existing condition exclusions. The Affordable Care Act prohibits medical underwriting.

Medicare

A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. The government pays providers for each service a patient receives.

Medicare Advantage (MA)

A health insurance program of managed health care approved by Medicare and provided by private companies. Medicare Advantage plans combine Medicare Part A (hospital coverage) and B (doctor coverage) plus additional benefits all in one plan. Also known as Medicare Part C.

Cost-Sharing Reduction (CSR)

A provision in the Affordable Care Act that lowers the amount an individual pays out-of-pocket for deductibles, coinsurance, and copayments. Individuals can qualify if they…