Fraud and Incorrect Billing/Payments Sample Clauses

Fraud and Incorrect Billing/Payments. CONTRACTOR shall continue to maintain for ERS, as it may relate to ERS and the GBP, a comprehensive plan, as described in the RFP, including automated systems, to detect and prevent Participant and vision care provider fraud, malfeasance, criminal and improper activity, unnecessary vision treatments and procedures, unreasonably long delays for Participants to wait to obtain vision services, and other similar abuses and improprieties, including, but not limited to intentionally perpetrated fraud, theft, embezzlement, misappropriation of funds, commingling, misuse of the GBP, overcharges, overpayments, wrongful and incorrect payments, deceptive, and duplicate or suspicious ▇▇▇▇▇▇▇▇, and the failure to disclose material information (hereinafter collectively “Improprieties”) by CONTRACTOR, CONTRACTOR’s officers, employees, affiliates, agents, subsidiaries and independent contractors and subcontractors (to the extent their information is available to CONTRACTOR), and Participants. Whether or not an Impropriety exists or may have been committed includes, but is not limited to, by way of example, the following circumstances and/or factors: (a) if a person or entity, either intentionally or negligently, presents or causes to be presented to ERS, the GBP or CONTRACTOR a claim for services, eligible benefits, supplies or products, or for any other manner of payment or reimbursement that (i) contains any statement or representation that the person or entity knows or reasonably should have known was false or misleading, and/or (ii) fails to disclose material information; or (b) if CONTRACTOR or a vision care provider providing services for Participants refuses to provide an individual with a vision benefit or service that CONTRACTOR or the vision care provider is required to provide under this Contract or applicable laws and regulations; or (c) if CONTRACTOR or a vision care provider providing services for Participants repeatedly or explicitly refuses to provide information required to be provided to ERS by law or under this Contract (or to CONTRACTOR, in the case of vision care provider billing) in order to establish the legitimacy of a claim, charge or billing; or (d) if CONTRACTOR or any vision care provider engages in actions that indicate a pattern of wrongful denial of reimbursement for eligible benefits or services that CONTRACTOR or any vision care provider is required to provide under this Contract or applicable laws and regulations, or that indicate a patter...
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Related to Fraud and Incorrect Billing/Payments

  • Payments From and after the Effective Date, the Administrative Agent shall make all payments in respect of the Assigned Interest (including payments of principal, interest, fees and other amounts) to the Assignor for amounts which have accrued to but excluding the Effective Date and to the Assignee for amounts which have accrued from and after the Effective Date.

  • Final Payment A. Upon final completion and acceptance of the Work in accordance with Paragraph 15.06 of the General Conditions, Owner shall pay the remainder of the Contract Price as recommended by Engineer as provided in said Paragraph 15.06.

  • Invoices Each invoice or pay request shall include the TIPS Member’s purchase order number or other identifying designation as provided in the order by the TIPS Member. If applicable, the shipment tracking number or pertinent information for verification of TIPS Member receipt shall be made available upon request.

  • Wages A transferring employee will be paid in accordance with the collective agreement of the designated employer.

  • Taxes The Company shall pay, and shall cause each of its Subsidiaries to pay, prior to delinquency, all material taxes, assessments, and governmental levies except such as are contested in good faith and by appropriate proceedings or where the failure to effect such payment is not adverse in any material respect to the Holders of the Notes.