of an annual contracted reconciliation of a risk-sharing
arrangement under an administrative service provider contract.
§ 3702. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Abuse." Incidents or practices of providers, physicians or
suppliers of services and equipment which are inconsistent with
accepted sound medical, business or fiscal practices.
" Fraud. " Any activity defined as an offense under 18 Pa.C.S.
§ 4117 (relating to insurance fraud).
" Health care provider. " A person, corporation, facility,
institution or other entity licensed, certified or approved by
the Commonwealth to provide health care or professional medical
services. The term includes, but is not limited to, a physician,
chiropractor, optometrist, professional nurse, certified nurse-
midwife, podiatrist, hospital, nursing home, ambulatory surgical
center or birth center.
" Insurer. " A health insurance entity licensed in this
Commonwealth to issue any individual or group health, sickness
or accident policy or subscriber contract or certificate that
provides medical or health care coverage by a health care
facility or licensed health care provider that is offered or
governed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
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