Common use of Program Integrity Requirements Clause in Contracts

Program Integrity Requirements. Provider shall comply with Wellpoint's HCA approved program integrity policies and procedures and the program integrity requirements of the Government Contract including, but not limited to, compliance with section 1902(a)(68) of the Social Security Act, 42 C.F.R. § 438.610, 42 C.F.R. §455, 42 C.F.R. §1000 through 1008 and Chapter 182-502A WAC. If Provider is defined as a subcontractor under the Government Contract, Provider shall verify that services billed by Provider were actually provided to Medicaid Members and shall conduct ongoing analysis of utilization, claims, billing and/or encounter data to detect overpayments and including audits and investigations of Provider's subcontractors and downstream entities.

Program Integrity Requirements. Provider shall comply with Wellpoint's HCA approved program integrity policies and procedures and the program integrity requirements of the Government Contract includingContract, including but not limited to, to compliance with section 1902(a)(68) of the Social Security Act, 42 C.F.R. § 438.610, 42 C.F.R. §455, 42 C.F.R. §1000 through 1008 and Chapter 182-502A WAC. If Provider is defined as a subcontractor under the Government Contract, Provider shall verify that services billed by Provider were actually provided to Medicaid Members and shall conduct ongoing analysis of utilization, claims, billing and/or encounter data to detect overpayments and including audits and investigations of Provider's subcontractors and downstream entities.