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Common use of Abuse Clause in Contracts

Abuse. As defined in 42 CFR 455.2, Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet the professionally recognized standards for health care. It also includes beneficiary practices that result in unnecessary cost to the Medicaid program.

Appears in 3 contracts

Samples: Provider Service Agreement, Provider Service Agreement, Provider Service Agreement

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Abuse. As defined in 42 CFR 455.2, Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid programor Medicare Program, or in reimbursement for services that are not medically necessary Medically Necessary or that fail to meet the professionally recognized standards for health care. It also includes beneficiary Enrollee practices that result in an unnecessary cost to the Medicaid programor Medicare Program.

Appears in 2 contracts

Samples: Contract, Contract

Abuse. As defined in 42 CFR 455.2, Provider practices that are inconsistent with sound fiscal, business, or medical practices practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary Medically Necessary or that fail to meet the professionally recognized standards for health care. It also includes beneficiary Member practices that result in unnecessary cost to the Medicaid program.. [42 C.F.R. § 455.2]

Appears in 1 contract

Samples: Medicaid Managed Care Services Agreement

Abuse. As defined in 42 CFR 455.2, Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet the professionally recognized standards for health care. It also includes beneficiary practices that result in unnecessary cost to the Medicaid programhealthcare.

Appears in 1 contract

Samples: Service Agreement

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Abuse. As defined in 42 CFR 455.2, Provider practices that are inconsistent with sound fiscal, business, business or medical practices and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet the professionally recognized standards for health care. It also includes beneficiary practices that result in unnecessary cost to the Medicaid programhealthcare.

Appears in 1 contract

Samples: Provider Service Agreement

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