Federal program that combines medical, social, and long-term care services for frail people. It is a provider under Medicare and available only in states that have chosen to offer it under the Medicaid program. An individual’s eligibility requires that he or she be 55 years or older, live in the service area of the PACE program, be certified as eligible for nursing home care by the appropriate state agency, and be able to live safely in the community. PACE’s goal is to help people stay independent and live in their community as long as possible while getting the high-quality care they need.

Contractor hired to investigate an allegation of fraud and establish a case after it is substantiated. Also called contractor. Also see potential fraud case (PSC).

Written notation, dated and signed, by a member of the health care team, that summarizes the facts about the medical care given and the patient’s response during a specific period of time. Also called chart note.

Written or dictated letter or chart note documenting details about subsequent examinations of the patient.

System of giving medically necessary health care at any given stage in illness or recovery (i.e., from acute care in a hospital through the recuperation phase).

A temporary or permanent increase in severity of impairment of a body part, organ, or system. This may be due to disease or injury (e.g., hearing loss going from bad to worse).

System in which an insurance plan employs new rates either monthly, quarterly, or semiannually. Individuals who apply or renew policies are affected by the rates in effect.

Supervises and administers the implementation of a data system that can support personal health records and website content.

Appointed person who is responsible overall for a project. A departmental person is usually appointed.

Potential insurance claim costs that are expected for a specific group over a time period.