Oversight and Monitoring. Health Plan and/or Subcontractor shall perform ongoing monitoring of services rendered by Provider, shall perform periodic audits and formal reviews of Provider consistent with the requirements of the applicable state contract and State and federal law and regulations. In the event Health Plan and/or Subcontractor identifies deficiencies or areas for improvement, Provider shall take appropriate corrective action to address such deficiencies, concerns or recommendations for improvement. Additionally, Provider shall cooperate fully with Health Plan’s and/or Subcontractor’s policies and the Deficit Reduction Act of 2005 (DRA) to protect program integrity and prevent and detect potential or suspected fraud, waste, and abuse in the administration and delivery of services under the state contract and shall cooperate and assist Health Plan and/or Subcontractor, and any State or federal agency charged with the duty of preventing, identifying, investigating, sanctioning or prosecuting suspected fraud, waste, and abuse in state and/or federal health care programs.
Appears in 3 contracts
Sources: Downstream Provider Regulatory Requirements Appendix, Downstream Provider Regulatory Requirements Appendix, Downstream Provider Regulatory Requirements Appendix