Common use of Enforcing Compliance Clause in Contracts

Enforcing Compliance. When a participating Contractor is found to be out of compliance through a desk audit, onsite audit or other means of oversight, the following principles and guidelines will apply: A. Any claim(s) for the date(s) in question may be recalculated by the HSD based on the audit findings, and the recalculated claim approved for payment. B. Any claim(s) for the date(s) in question may be denied totally or in part. C. The Contractor may be required to submit a Corrective Action Plan to the HSD, within thirty (30) days from the date of the HSD’s Report of Audit Findings, stating how the Contractor intends to remedy the non-compliance issues identified in the audit report. D. Funds required to be reimbursed by the Contractor, as a result of the HSD’s audit findings, may be recouped by direct payment to the HSD or by offset against the Contractor’s direct and/or administrative claims. E. The Contractor has the right to appeal the HSD’s audit findings and related issues through the administrative hearing process, pursuant to the Medicaid provider hearing regulations at §8.353.2 NMAC.

Enforcing Compliance. When a participating Contractor is found to be out of compliance through a desk audit, onsite audit or other means of oversight, the following principles and guidelines will apply: A. Any claim(s) for the date(s) in question may be recalculated by the HSD based on the audit findings, and the recalculated claim approved for payment. B. Any claim(s) for the date(s) in question may be denied totally or in part. C. The Contractor may be required to submit a Corrective Action Plan to the HSD, within thirty (30) days from the date of the HSD’s Report of Audit Findings, stating how the Contractor intends to remedy the non-compliance issues identified in the audit report. D. Funds required to be reimbursed by the Contractor, as a result of the HSD’s audit findings, may be recouped by direct payment to the HSD or by offset against the Contractor’s direct and/or administrative claims. E. The Contractor has the right to appeal the HSD’s audit findings and related issues through the administrative hearing process, pursuant to the Medicaid provider hearing regulations at §8.353.2 8.352.3 NMAC.