Compliance Program and Anti-Fraud Initiatives. Participant shall (and shall contractually require its Practice Providers and Suppliers to) institute, operate, and maintain an effective compliance program to detect, correct and prevent the incidence of non-compliance with Applicable Requirements and the incidence of fraud, waste and abuse relating to the MSSP and the federal healthcare program generally. Such compliance program shall be appropriate to Participant, Practice Providers’, or Supplier’s organization and operations and shall include:
Compliance Program and Anti-Fraud Initiatives. Provider shall (and shall cause its Downstream Entities to) institute, operate, and maintain an effective compliance program to detect, correct and prevent the incidence of non-compliance with CMS requirements and the incidence of fraud, waste and abuse relating to the operation of Company’s Medicare Program. Such compliance program shall be appropriate to Provider or Downstream Entity’s organization and operations and shall include: (a) written policies, procedures and standards of conduct articulating the entity’s commitment to comply with Federal and State laws; and (b) for all officers, directors, employees, contractors and agents of Provider or Downstream Entity, required participation in effective compliance and anti-fraud training and education that is consistent with guidance that CMS has or may issue with respect to compliance and anti-fraud and abuse initiatives, unless exempt from such training under relevant CMS regulations.
Compliance Program and Anti-Fraud Initiatives. Provider shall (and shall cause its Downstream Entities to) institute, operate, and maintain an effective compliance program to detect, correct and prevent the incidence of non- compliance with CMS requirements and the incidence of fraud, waste and abuse (FWA) relating to the operation of HCS’s Medicare Program. Such compliance program shall be appropriate to Provider's or Downstream Entity's organization and operations and shall include:
Compliance Program and Anti-Fraud Initiatives. The ACO shall develop and maintain an effective compliance program to detect, correct and prevent incidences of non-compliance with Applicable Requirements and incidences of fraud, waste and abuse relating to the MSSP and the federal healthcare program generally. The Participant shall comply with all requirements of the ACO’s compliance program. The ACO’s compliance program shall be appropriate to the ACO’s operations, shall be in compliance with, and be updated periodically to reflect changes in, law and regulations, and shall include at least the following elements:
Compliance Program and Anti-Fraud Initiatives. EIP shall develop and maintain an effective compliance program to detect, correct and prevent incidences of non-compliance with Applicable Requirements and incidences of fraud, waste and abuse relating to Model 4 and the federal healthcare program generally. Practice and Participating Physicians shall, and Practice shall contractually require its Providers to, comply with all requirements of EIP’s compliance program. EIP’s compliance program shall be appropriate to EIP’s operations, shall be in compliance with, and be updated periodically to reflect changes in, law and regulations, and shall include at least the following elements:
Compliance Program and Anti-Fraud Initiatives. Producer shall (and shall cause its Downstream Entities to) institute, operate, and maintain an effective compliance program to detect, correct and prevent the incidence of non- compliance with CMS requirements and the incidence of fraud, waste and abuse (FWA) relating to the operation of Company’s Medicare Program. Such compliance program shall be appropriate to Producer or Downstream Entity’s organization and operations and shall include:
Compliance Program and Anti-Fraud Initiatives. Upline shall (and shall cause its subcontractors to) institute, operate, and maintain an effective compliance program to detect, correct and prevent the incidence of non-compliance with CMS requirements and the incidence of fraud, waste and abuse (FWA) relating to the operation of Aetna’s Medicare Program. Such compliance program shall be appropriate to Upline’s or subcontractor’s organization and operations and shall include:
Compliance Program and Anti-Fraud Initiatives. Provider shall maintain an effective compliance program to prevent, detect, and correct: (1) non- compliance with CMS’s program requirements and (2) fraud, waste, and abuse (“FWA”). Such compliance program shall include dissemination to employees and Downstream Entities of (a) written policies and/or standards of conduct articulating the entity’s commitment to compliance with Applicable Law, initially within ninety (90) days of hire/contracting, and at least annually thereafter, (b) communications regarding the obligation to report potential non- compliance or FWA issues (internally and to payers, including Company, as applicable), and a no-tolerance policy for retaliation or retribution for good faith reporting, and reporting mechanisms to employees and Downstream Entities, and (c) appropriate training and education to ensure familiarity with and compliance with the compliance program. Provider, through its compliance program, shall establish and maintain a process to: oversee and ensure that employees and Downstream Entities perform applicable services for Company’s MMPs consistent with this Agreement and Applicable Law and shall require implementation of disciplinary actions and corrective actions up to terminations where needed to ensure such compliance. Provider shall require that any Downstream Entity maintains an effective compliance program consistent with the requirements of this section. [42 C.F.R. §§ 422.504(i)(2)(i) and (iv)] and [42 C.F.R. §423.505].
Compliance Program and Anti-Fraud Initiatives. Agent will (and will cause its subcontractors to) institute, operate and maintain an effective compliance program to detect, correct and prevent the incidence of non-compliance with CMS requirements and the incidence of fraud, waste and abuse (“FWA”) relating to the provision of services to Covered Persons. Such compliance program will be appropriate to Agent’s or subcontractor’s organization and operations. Agent will also comply with the terms of Plan’s FWA policies and procedures as set forth in the Plan’s policies and procedures. [42 C.F.R. §422.503(b)(vii)(C)]
Compliance Program and Anti-Fraud Initiatives. CompCare shall require CompCare Providers to undertake such compliance activities that may be required by CMS and/or that Health Plans determine is necessary for Health Plans to comply with their contracts with CMS and/or Applicable Law.
