Fraud and Abuse Compliance. (A) To Borrower’s knowledge (after due inquiry and investigation), none of Borrower, Property Manager or any of their Affiliates or any of their officers, directors, agents or employees, nor any agent acting on behalf of or for the benefit of any of the foregoing, has directly or indirectly in connection with Borrower or Property Manager or otherwise: (A) offered or paid any remuneration, in cash or in kind to, or made any financial arrangements with, any past, present or potential customers, past or present suppliers, patients, medical provider members, contractors or third party payors of Borrower or Property Manager in violation of applicable law; (B) given or agreed to give, or is aware that there has been made or that there is any agreement to make, any gift or gratuitous payment of any kind, nature or description (whether in money, property or services) to any customer or potential customer, supplier or potential supplier, contractor, third party payor or any other person in violation of applicable law; (C) made or agreed to make, or is aware that there has been made or that there is any agreement to make, any contribution, payment of gift of funds or property to, or for the private use of, any governmental official, employee or agent where either the contribution, payment or gift or the purpose of such contribution, payment or gift is or was illegal under the laws of the United States or under the laws of any state or any other governmental entity having jurisdiction over such payment, contribution or gift; (D) established or maintained any unrecorded fund or asset for any purpose or made any misleading, false or artificial entries on any of its books or records for any reason; (E) made, or agreed to make, or is aware that there has been made or that there is any agreement to make, any payment to any person with the intention or understanding that any part of such payment would be used for any purpose other than that described in the documents supporting such payment.
Fraud and Abuse Compliance. Plan Initially and annually Yes Per 42 CFR 438.608, Contractor shall submit its compliance plan designed to guard against Fraud and Abuse to the Department for Prior Approval. This does not need to be provided to the Department separately by population. Marketing Marketing Gifts and Incentives Initially and as revised Yes Contractor shall submit all plans to distribute gifts and incentives, as well as description of gifts and incentives, for Prior Approval. Marketing Materials Initially and as revised Yes Contractor shall submit all Marketing Materials for Prior Approval. Contractor shall not be required to submit format changes for Prior Approval, provided there is no material change in the information conveyed. Marketing, Outreach and Education Plan Annually Yes As described in Section 4.17.5, Contractor shall submit descriptions of proposed Marketing concepts, strategies, and procedures for Prior Approval. Community Outreach Events Monthly, by the last day of the reporting month No Contractor shall submit to the Department a list of all previously approved community outreach events that occurred during the submission month. The report must include the Event name, date, time, address/location, county, audience type, estimated number of attendees and date of Department approval. Provider Network Primary care Provider, Hospital, and Affiliated Specialist File (CEB Provider File) No less often than weekly Yes Contractor shall submit to the Department or its designee, in a format and medium designated by the Department, an electronic file of Contractor’s PCPs, Hospitals and Affiliated Specialists. The primary care Providers must include, but not limited to, the following information: • Provider name, Provider number, office address, and telephone number; • Type of specialty (e.g., family practitioner, internist, oncologist, etc.), subspecialty if applicable, and treatment age ranges; • Identification of Group Practice, if applicable; • Geographic service area, if limited; • Areas of board-certification, if applicable; • Language(s) spoken by Provider and office staff; • Office hours and days of operation; • Special services offered to the deaf or hearing impaired (i.e., sign language, TDD/TTY, etc.); • Wheelchair accessibility status (e.g., parking, ramps, elevators, automatic doors, personal transfer assistance, etc.); • PCP indicator; • Primary care Provider gender and panel status (open or closed); and • Primary care Provider hospital affiliations, includ...
Fraud and Abuse Compliance. Program Integrity Plan 15
Fraud and Abuse Compliance. It is the intent of the Parties that this Agreement and the performance of the Parties’ duties hereunder shall not violate the Anti-Kickback Statute and/or the Xxxxx Law. Hospice and Nursing Facility acknowledge and agree that the compensation set forth herein represents the fair market value for the services described in this Agreement, and was negotiated in an arms-length transaction and was not determined in a manner which takes into account the volume or value of any referrals or business which may otherwise be generated between Hospice and Nursing Facility. This Agreement does not involve the counseling or promotion of a business arrangement that violates state or federal law. Nothing contained in this Agreement shall be construed in any manner as an obligation, inducement, solicitation, payment, or remuneration for the referral of services or items reimbursable by a federal health care program. Moreover, Hospice and Nursing Facility will comply, in all material respects, with all applicable federal, state, and local laws and regulations, including fraud and abuse laws and regulations.
Fraud and Abuse Compliance. PLAN -------------------------------
