Credible Allegation of Fraud. An allegation of fraud, which has been verified by the State (Division) and the Contractor, from any source, including but not limited to the following: a. Fraud hotline Complaints; b. Claims data mining; c. Patterns identified through provider audits, civil false claims cases and law enforcement investigations. Allegations are considered to be credible when they have indicia of reliability and the State Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case- by- case basis.
Appears in 6 contracts
Samples: Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco), Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco), Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco)
Credible Allegation of Fraud. An allegation of fraud, which has been verified by the State (Division) and the Contractor, from any source, including but not limited to the following:
a. Fraud hotline Complaints;
b. Claims data mining;
c. Patterns identified through provider audits, civil false claims cases and law enforcement investigations. Allegations are considered to be credible when they have indicia of reliability and the State Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case- case-by- case basis.
Appears in 4 contracts
Credible Allegation of Fraud. An allegation of fraud, which has been verified by the State (Division) and the Contractor, from any source, including but not limited to the following:
a. Fraud hotline Complaints;
b. Claims data mining;
c. Patterns identified through provider audits, civil false claims cases cases, and law enforcement investigations. Allegations are considered to be credible when they have indicia of reliability and the State Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case- by- by-case basis.
Appears in 3 contracts
Samples: Contractual Agreement, Contractual Agreement, Contractual Agreement
Credible Allegation of Fraud. An A credible allegation of fraud, which has been verified by the State (Division) and the Contractor, fraud is an allegation from any source, including but not limited to the followingfollowing in accordance with 42 C.F.R § 405.370:
a. Fraud hotline Complaints;complaints.
b. Claims data mining;.
c. Patterns identified through provider audits, civil false claims cases cases, and law enforcement investigations. Allegations are considered to be credible when they have indicia of reliability and the State Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case- by- case basisreliability.
Appears in 2 contracts
Samples: Healthy Opportunities Pilot: Network Lead Hso Model Contract, Healthy Opportunities Pilot: Network Lead Hso Model Contract
Credible Allegation of Fraud. An allegation of fraud, which has been verified by the State (Division) and the ContractorCCO, from any source, including but not limited to the following:
a. Fraud hotline Complaints;
b. Claims data mining;
c. Patterns identified through provider audits, civil false claims cases and law enforcement investigations. Allegations are considered to be credible when they have indicia of reliability and the State Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case- case-by- case basis.
Appears in 2 contracts
Samples: Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco), Contract Between the State of Mississippi Division of Medicaid and a Coordinated Care Organization (Cco)
Credible Allegation of Fraud. An allegation of fraud, which has been verified by the State (DivisionDOM) and the ContractorCCO, from any source, including but not limited to the following:
a. Fraud hotline Complaints;
b. Claims data mining;
c. Patterns identified through provider audits, civil false claims cases and law enforcement investigations. Allegations are considered to be credible when they have indicia of reliability and the State Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case- by- case-by-case basis.
Appears in 1 contract
