Fraud, ▇▇▇▇▇, and ▇▇▇▇▇ Sample Clauses

Fraud, ▇▇▇▇▇, and ▇▇▇▇▇. 6.1.1 Fraud, Waste, and ▇▇▇▇▇, Generally (A) Pursuant to 42 CFR § 438.608, the Contractor or Subcontractor to the extent the Subcontractor is delegated responsibility for coverage of services and payment of Claims, shall implement and maintain arrangements or procedures, including a mandatory compliance plan, that are designed to guard against Fraud, Waste, and Abuse on the part of the Providers, Enrollees, and other patients who falsely present themselves as being Medicaid eligible. (B) The Contractor or Subcontractor shall have a written compliance plan designed to identify and refer suspected Fraud, Waste, or Abuse activities. The Contractor shall submit the compliance plan to the Department by July 1st of each year which shall be subject to the Department's approval. If the Department does not provide a response to the Contractor within 90 calendar days of receiving the compliance plan, it will be deemed approved. (C) The Contractor’s compliance plan shall designate the staff members and other resources being allocated to the prevention, detection, investigation and referral of suspected Provider Fraud, Waste, and Abuse. (D) The Contractor’s compliance plan shall include a description of the Contractor’s payment suspension process and how this process is in compliance with Article 6.
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇. Contractor understands that in the event County becomes aware of any allegation or a finding of fraud, waste, or misuse of funds received from the Office of the Governor that is made against the Contractor, the County is required to immediately notify OOG of said allegation or finding and to continue to inform OOG of the status of any such on-going investigations. The County must also promptly refer to OOG any credible evidence that a principal, employee, agent, contractor, subcontractor, or other person has -- (1) submitted a claim for award funds that violates the False Claims Act; or (2) committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving award funds. County must also immediately notify OOG in writing of any misappropriation of funds, fraud, theft, embezzlement, forgery, or any other serious irregularities indicating noncompliance with grant requirements. County must notify the local prosecutor's office of any possible criminal violations.
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇. ▇▇▇▇▇, Waste, and ▇▇▇▇▇, Generally
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇. Participating Producers and its Personnel must complete Compliance, Fraud, Waste and Abuse training within 90 days of their hiring date, or for those already employed or under contract, and who have not received such training within the past 180 days, within 60 days of the Effective Date of this Agreement. In the case of Personnel not currently contracted as of the Effective Date of this Agreement, Personnel must complete Compliance, Fraud, Waste and Abuse training within 60 days of the applicable agreement being signed. Proof of this training, including attendance, topic and certificate of completion for each Participating Producer and its Personnel, must be kept for a minimum of 10 years, and evidence of such training must presented to General Agent upon request. The training should be conducted using the standardized CMS-developed training and educations may publicly available by CMS.
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇. 6.1.1 Fraud, Waste, and ▇▇▇▇▇, Generally (A) Pursuant to 42 CFR § 438.608, the Contractor or Subcontractor to the extent the Subcontractor is delegated responsibility for coverage of services and payment of Claims, shall implement and maintain arrangements or procedures, including a mandatory compliance plan, that are designed to guard against Fraud, Waste, and Abuse on the part of the Providers, Enrollees, and other patients who falsely present themselves as being Medicaid eligible. (B) The Contractor or Subcontractor shall have a written compliance plan designed to identify and refer suspected Fraud, Waste, or Abuse activities. (C) The Contractor’s compliance plan shall include a description of the Contractor’s Fraud, Waste, and Abuse case management tracking system. If the Contractor does not have a Fraud, Waste, and Abuse case management tracking system the Contractor shall describe its plans to develop such a tracking system. (D) The Contractor’s compliance plan shall designate the staff members and other resources being allocated to the prevention, detection, investigation and referral of suspected Provider Fraud, Waste, and ▇▇▇▇▇. (E) The Contractor’s compliance plan shall include a description of the Contractor’s payment suspension process and how this process is in compliance with Article 6.1.5 of this attachment. (F) The Contractor shall submit the compliance plan to the Department by July 1st of each year which shall be subject to the Department's approval. If the Department does not provide a response to the Contractor within 90 calendar days of receiving the compliance plan, it will be deemed approved. (G) The Contractor shall cooperate and coordinate with the Department, the Utah Office of Inspector General of Medicaid Services (Utah OIG), and MFCU in any Waste, Fraud, and Abuse activities and investigations. (H) The Contractor shall make reasonable efforts to attend and participate in quarterly Fraud, Waste, and Abuse meetings with the Department, MFCU, and the Utah OIG.
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇. 2.16.1 Provider will cooperate with the MCO and any State, Federal programs related to anti-fraud compliance program. If Provider identifies any actual or suspected fraud, abuse or misconduct in connection with the services rendered hereunder in violation of state or federal law, Provider will immediately report such activity directly to the MCO's Chief Compliance Officer or in accordance with the Provider Manual. Provider is not limited in any respect in reporting actual or suspected fraud, abuse, or misconduct to the MCO. 2.16.2 The Provider understands and agrees: (1) it must allow the MCO, the HHSC OIG, and the Texas Medicaid Fraud Control Unit to conduct private interviews of patients and the Provider, including its employees, agents, and subcontractors; (2) it must comply with requests for information from such entities in the form and language requested; (3) the Provider and its employees, agents, and subcontractors must cooperate fully with these entities in making themselves available in person for interviews, consultation, grand jury proceedings, pre-trial conference, hearings, trials and in any other process, including investigations; and (4) compliance with these requirements will be at the Provider’s own expense. 2.16.3 The Provider understands and agrees: (1) it is subject to all state Regulatory Requirements relating to Fraud, Waste, or Abuse in health care and the STAR+PLUS Program; (2) it must cooperate and assist HHSC and any state or federal agency that is charged with the duty of identifying, investigating, sanctioning or prosecuting suspected Fraud, Waste, or Abuse; (3) it must provide originals or copies of any and all information as requested by HHSC or the state or federal agency, allow access to premises, and provide records to the HHSC OIG, HHSC, CMS, HHS, HHS OIG, FBI, TDI, the Texas Attorney General’s Medicaid Fraud Control Unit or other unit of state or federal government, upon request, and free-of-charge; (4) If it places required records in another legal entity's records, the Provider is responsible for obtaining a copy of these records for use by the above-named entities or their representatives; and (5) it must report any suspected Fraud, Waste, or Abuse including any suspected Fraud, Waste, or Abuse committed by the MCO or a Member to the HHSC OIG. 2.16.4 If the Provider receives annual Medicaid payments of at least $5 million (cumulative, from all sources), the Provider must: (1) Establish written policies for all of the ...
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇ 
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Fraud, ▇▇▇▇▇, and ▇▇▇▇▇ 
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Related to Fraud, ▇▇▇▇▇, and ▇▇▇▇▇

  • Fraud, ▇▇▇▇▇ and Abuse If you have concerns about being billed for services you never received, or that your insurance information has been stolen or used by someone else, you may report potential health care fraud, waste or abuse to our Special Investigations Unit by using our confidential anti-fraud hotline at ▇-▇▇▇-▇▇▇-▇▇▇▇ or by email at ▇▇▇@▇▇▇▇▇▇.▇▇▇. You may also send an anonymous letter to us at: Blue Cross & Blue Shield of Rhode Island Special Investigations Unit ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ Providence RI, 02903

  • PREVENTION OF FRAUD AND ▇▇▇▇▇▇▇ 37.1 The Supplier represents and warrants that neither it, nor to the best of its knowledge any Supplier Personnel, have at any time prior to the Framework Commencement Date: 37.1.1 committed a Prohibited Act or been formally notified that it is subject to an investigation or prosecution which relates to an alleged Prohibited Act; and/or 37.1.2 been listed by any government department or agency as being debarred, suspended, proposed for suspension or debarment, or otherwise ineligible for participation in government procurement programmes or contracts on the grounds of a Prohibited Act. 37.2 The Supplier shall not during the Framework Period: 37.2.1 commit a Prohibited Act; and/or 37.2.2 do or suffer anything to be done which would cause the Authority or any of the Authority’s employees, consultants, contractors, sub- contractors or agents to contravene any of the Relevant Requirements or otherwise incur any liability in relation to the Relevant Requirements. 37.3 The Supplier shall during the Framework Period: 37.3.1 establish, maintain and enforce, and require that its Sub-Contractors establish, maintain and enforce, policies and procedures which are adequate to ensure compliance with the Relevant Requirements and prevent the occurrence of a Prohibited Act; 37.3.2 keep appropriate records of its compliance with its obligations under Clause 37.3.1 and make such records available to the Authority on request; 37.3.3 if so required by the Authority, within twenty (20) Working Days of the Framework Commencement Date, and annually thereafter, certify in writing to the Authority, the compliance with this Clause 37.3 of all persons associated with the Supplier or its Sub-Contractors who are responsible for supplying the Goods and/or Services in connection with this Framework Agreement. The Supplier shall provide such supporting evidence of compliance as the Authority may reasonably request; and 37.3.4 have, maintain and where appropriate enforce an anti-bribery policy (which shall be disclosed to the Authority on request) to prevent it and any Supplier Personnel or any person acting on the Supplier's behalf from committing a Prohibited Act. 37.4 The Supplier shall immediately notify the Authority in writing if it becomes aware of any breach of Clause 37.1, or has reason to believe that it has or any of the Supplier Personnel has: 37.4.1 been subject to an investigation or prosecution which relates to an alleged Prohibited Act; 37.4.2 been listed by any government department or agency as being debarred, suspended, proposed for suspension or debarment, or otherwise ineligible for participation in government procurement programmes or contracts on the grounds of a Prohibited Act; and/or 37.4.3 received a request or demand for any undue financial or other advantage of any kind in connection with the performance of this Framework Agreement or otherwise suspects that any person or Party directly or indirectly connected with this Framework Agreement has committed or attempted to commit a Prohibited Act. 37.5 If the Supplier makes a notification to the Authority pursuant to Clause 37.4, the Supplier shall respond promptly to the Authority's enquiries, co-operate with any investigation, and allow the Authority to audit any books, records and/or any other relevant documentation in accordance with Clause 15 (Records, Audit Access and Open Book Data). 37.6 If the Supplier breaches Clause 37.1, the Authority may by notice: 37.6.1 require the Supplier to remove from the performance of this Framework Agreement any Supplier Personnel whose acts or omissions have caused the Supplier’s breach; or 37.6.2 immediately terminate this Framework Agreement for material Default. 37.7 Any notice served by the Authority under Clause 37.6 shall specify the nature of the Prohibited Act, the identity of the Party who the Authority believes has committed the Prohibited Act and the action that the Authority has elected to take (including, where relevant, the date on which this Framework Agreement shall terminate).

  • Fraud, Waste, and Abuse Contractor understands that HHS does not tolerate any type of fraud, waste, or abuse. Violations of law, agency policies, or standards of ethical conduct will be investigated, and appropriate actions will be taken. Pursuant to Texas Government Code, Section 321.022, if the administrative head of a department or entity that is subject to audit by the state auditor has reasonable cause to believe that money received from the state by the department or entity or by a client or contractor of the department or entity may have been lost, misappropriated, or misused, or that other fraudulent or unlawful conduct has occurred in relation to the operation of the department or entity, the administrative head shall report the reason and basis for the belief to the Texas State Auditor’s Office (SAO). All employees or contractors who have reasonable cause to believe that fraud, waste, or abuse has occurred (including misconduct by any HHS employee, Grantee officer, agent, employee, or subcontractor that would constitute fraud, waste, or abuse) are required to immediately report the questioned activity to the Health and Human Services Commission's Office of Inspector General. Contractor agrees to comply with all applicable laws, rules, regulations, and System Agency policies regarding fraud, waste, and abuse including, but not limited to, HHS Circular C-027. A report to the SAO must be made through one of the following avenues: ● SAO Toll Free Hotline: 1-800-TX-AUDIT ● SAO website: ▇▇▇▇://▇▇▇.▇▇▇▇▇.▇▇▇▇▇.▇▇.▇▇/ All reports made to the OIG must be made through one of the following avenues: ● OIG Toll Free Hotline ▇-▇▇▇-▇▇▇-▇▇▇▇ ● OIG Website: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ ● Internal Affairs Email: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇.▇▇ ● OIG Hotline Email: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇.▇▇. ● OIG Mailing Address: Office of Inspector General Attn: Fraud Hotline MC 1300 P.O. Box 85200 Austin, Texas 78708-5200

  • Fraud Prevention A. To screen its employees and contractors to determine if they have been excluded from Medicare, Medicaid or any federal or state health care program. The Contractor agrees to search monthly the HHS-Office of Inspector General ("OIG") and Texas Health and Human Services Commission Office of Inspector General ("HHSC-OIG") List of Excluded Individuals/Entities ("LEIE") websites to capture exclusions and reinstatements that have occurred since the last search and to immediately report to HHSC-OIG any exclusion information the Contractor discovers. Exclusionary searches for prospective employees and contractors shall be performed prior to employment or contracting. B. That no Medicaid payments can be made for any items or services directed or prescribed by a physician or other authorized person who is excluded from Medicare, Medicaid or any federal or state health care program when the individual or entity furnishing the items or services either knew or should have known of the exclusion. This prohibition applies even when the Medicaid payment itself is made to another contractor, practitioner or supplier who is not excluded. C. That this contract is subject to all state and federal laws and regulations relating to fraud and abuse in health care and the Medicaid program. As required by 42 C.F.R. §431.107, the Contractor agrees to keep all records necessary to disclose the extent of services the Contractor furnishes to people in the Medicaid program and any information relating to payments claimed by the Contractor for furnishing Medicaid services. On request, the Contractor also agrees to furnish HHSC, AG-MFCU, or HHS any information maintained under 42 C.F.