Health insurance plan that covers a subscriber or member and one or more dependents.

Life insurance contract that insures all or several family members. Usually the husband is under a whole life arrangement and the rest of the family is under term insurance, as well as those born after issuance of the policy.

Medical doctor (MD) of the specialty of family medicine. He or she has usually completed a residency program in the specialty of family practice. Services may include internal medicine, pediatrics, and some surgical procedures. See general practitioner . Also called family practice physician .

System in a managed care plan of choosing insurance subscribers or covered lives based on statistical data that show use of medical services in a particular population group to be lower than estimated or anticipated. See also cherry picking .

Guaiac-based test for peroxidase activity that the patient completes by taking samples from two different sites of three consecutive stools. CPT codes 82270 through 82274 and HCPCS codes G0107 and G0328 apply to this test.

System established for the codification and publication of uniform policies and procedures for acquisition by all executive government agencies.

Government agency that investigates and prosecutes federal offenses and criminal activities. It plays an active role in investigating health insurance fraud and abuse related to federal or private health insurance programs. It has direct access to Medicare administrative contractor data and other records.

Federal workers’ compensation plan administered by the U.S. Department of Labor (DOL). This act, also referred to as the Black Lung Benefits Act , became effective on May 7, 1941. Services for Medicare patients with diagnoses related to black lung are billed to the DOL for reimbursement. Also known as the Black Lung Program .

Federal legislation that protects the confidentiality of the identity, diagnosis, prognosis, and treatment of any patient for drug abuse.