Common use of Audit, Evaluation and Assessment Clause in Contracts

Audit, Evaluation and Assessment. Each Physician acknowledges and agrees that the auditing authority of the Medical Services Commission under section 36 the Medicare Protection Act, as amended from time to time, applies to this Contract. Each Physician acknowledges and agrees that: (i) knowingly submitting reporting under this Contract for Services or hours that were not rendered, or that misrepresents the nature or extent of the Services or hours rendered, including but not limited to diagnostic coding; or (ii) double billing, including FFS claims contrary to this Contract, is a fundamental breach of this Contract and “cause” within the meaning of section 15 of the Medicare Protection Act. Without limiting section 22.1 or 22.2 above, each Physician acknowledges and agrees that the terms in sections 36(3) to 36(12) of the Medicare Protection Act are hereby incorporated into this Contract for the purposes of audits in relation to this Contract, and that: (i) each Physician and any other person (as defined in the Interpretation Act) who owns, manages, controls or carries on business in relation to the Clinic is a “person described in section (2)(b) or (c)” within the incorporated meaning of s. 36(5)(a) from the Medicare Protection Act; and (ii) auditors of the Agency and Medical Services Commission (the “Auditors”) are “inspectors” within the incorporated meaning of sections 36(3) to 36(12) of the Medicare Protection Act. Notwithstanding section 22.3 above, an Agency Auditor may not directly access the Practice EMR, unless the Physician permits access by the Agency Auditor. Prior to attending the Clinic for audit under section 22.3 above, a notice of inspection of an audit must be provided to the Physicians. Unless determined otherwise by the Medical Services Commission, which in no case would include a random audit, notice of inspection must be provided at least 14 days prior to the inspection. Each Physician must reasonably cooperate with Auditors for an audit in relation to this Contract, including by allowing Medical Services Commission Auditors to access the Practice EMR. A Physician’s failure to reasonably cooperate is a fundamental breach of this Contract for which the Agency may immediately terminate the Contract with one or more Physician(s) – up to and including all Physicians – upon written notice to Physician(s). The Physicians agree that any monies received from sources in relation to Services that are not permitted by this Contract will reduce the amount owing by the Agency under this Contract, which the Agency may set-off immediately upon discovery of the additional payment.

Audit, Evaluation and Assessment. Each 21.1 The Physician acknowledges and agrees that the auditing authority of the Medical Services Commission under section 36 of the Medicare Protection Act, as amended from time to time, applies to this Contract. Each . 21.2 The Physician acknowledges and agrees that: (i) knowingly submitting reporting under this Contract for Services or hours that were not rendered, or that misrepresents the nature or extent of the Services or hours rendered, including but not limited to diagnostic coding; or (ii) double billing, including FFS claims contrary to this Contract, is a fundamental breach of this Contract and “cause” within the meaning of section 15 of the Medicare Protection Act. . 21.3 Without limiting section 22.1 21.1 or 22.2 21.2 above, each the Physician acknowledges and agrees that the terms in sections 36(3) to 36(12) of the Medicare Protection Act are hereby incorporated into this Contract for the purposes of audits in relation to this Contract, and that: (i) each the Physician and any other person (as defined in the Interpretation Act) who owns, manages, controls or carries on business in relation to the Clinic Practice is a “person described in section (2)(b) or (c)” within the incorporated meaning of s. 36(5)(a) from the Medicare Protection Act; and (ii) auditors of the Agency and Medical Services Commission (the “Auditors”) are “inspectors” within the incorporated meaning of sections 36(3) to 36(12) of the Medicare Protection Act. . 21.4 Notwithstanding section 22.3 21.3 above, an Agency Auditor may not directly access the Practice EMR, EMR unless the Physician permits access by the Agency Auditor. . 21.5 Prior to attending the Clinic for audit under section 22.3 21.3 above, a notice of inspection of an audit must be provided to the PhysiciansPhysician. Unless determined otherwise by the Medical Services Commission, which in no case would include a random audit, notice of inspection must be provided at least 14 days prior to the inspection. Each . 21.6 The Physician must reasonably cooperate with Auditors for an audit in relation to this Contract, including by allowing Medical Services Commission Auditors to access the Practice EMR. A The Physician’s failure to reasonably cooperate is a fundamental breach of this Contract for which the Agency may immediately terminate the Contract with one or more Physician(s) – up to and including all Physicians – the Physician upon written notice to Physician(s). notice. 21.7 The Physicians agree Physician agrees that any monies received from sources in relation to Services that are not permitted by this Contract will reduce the amount owing by the Agency under this Contract, which the Agency may set-off immediately upon discovery of the additional payment.

Audit, Evaluation and Assessment. 23.1 Each Physician acknowledges and agrees that the auditing authority of the Medical Services Commission under section 36 the Medicare Protection Act, as amended from time to time, applies to this Contract. . 23.2 Each Physician acknowledges and agrees that: (i) knowingly submitting reporting under this Contract for Services or hours that were not rendered, or that misrepresents the nature or extent of the Services or hours rendered, including but not limited to diagnostic coding; or (ii) double billing, including FFS claims contrary to this Contract, is a fundamental breach of this Contract and “cause” within the meaning of section 15 of the Medicare Protection Act. . 23.3 Without limiting section 22.1 23.1 or 22.2 23.2 above, each Physician acknowledges and agrees that the terms in sections 36(3) to 36(12) of the Medicare Protection Act are hereby incorporated into this Contract for the purposes of audits in relation to this Contract, and that: (i) each Physician and any other person (as defined in the Interpretation Act) who owns, manages, controls or carries on business in relation to the Clinic is a “person described in section (2)(b) or (c)” within the incorporated meaning of s. 36(5)(a) from the Medicare Protection Act; and (ii) auditors of the Agency and Medical Services Commission (the “Auditors”) are “inspectors” within the incorporated meaning of sections 36(3) to 36(12) of the Medicare Protection Act. . 23.4 Notwithstanding section 22.3 23.3 above, an Agency Auditor may not directly access the Practice EMR, unless the Physician permits access by the Agency Auditor. . 23.5 Prior to attending the Clinic for audit under section 22.3 23.3 above, a notice of inspection of an audit must be provided to the Physicians. Unless determined otherwise by the Medical Services Commission, which in no case would include a random audit, notice of inspection must be provided at least 14 days prior to the inspection. . 23.6 Each Physician must reasonably cooperate with Auditors for an audit in relation to this Contract, including by allowing Medical Services Commission Auditors to access the Practice EMR. A Physician’s failure to reasonably cooperate is a fundamental breach of this Contract for which the Agency may immediately terminate the Contract with one or more Physician(s) – up to and including all Physicians – upon written notice to Physician(s). . 23.7 The Physicians agree that any monies received from sources in relation to Services that are not permitted by this Contract will reduce the amount owing by the Agency under this Contract, which the Agency may set-off immediately upon discovery of the additional payment.