Common use of Fraud and Abuse Reporting Requirements Clause in Contracts

Fraud and Abuse Reporting Requirements. i) The Contractor must submit quarterly, via the HPN complaint reporting format, the number of complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. ii) The Contractor must also submit to the SDOH the following on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etc: A) The name of the individual or entity that committed the fraud or abuse; B) The source that identified the fraud or abuse; C) The type of provider, entity or organization that committed the fraud or abuse; D) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3 E) The approximate range of dollars involved; F) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and G) Other data/information as prescribed by SDOH. iii) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. iA) The Contractor must submit quarterly, via the HPN complaint Complaint reporting format, the number of complaints Complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. iiB) The Contractor also must also submit to the SDOH the following information on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaintsComplaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etcor any other source: AI) The name of the individual or entity that committed the fraud or abuse; BII) The source that identified the fraud or abuse; CIII) The type of provider, entity or organization that committed the fraud or abuse; DIV) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; EV) The approximate range dollar amount of dollars involvedthe fraud or abuse; FVI) The legal and administrative disposition of the case case, if available, including actions taken by law enforcement officials to whom the case has been referred; and GVII) Other data/information as prescribed by SDOH. iiiC) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. i) The Contractor must submit quarterly, via the HPN complaint reporting format, the number of complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. ii) The Contractor must also submit to the SDOH the following on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etc: A) The name of the individual or entity that committed the fraud or abuse; B) The source that identified the fraud or abuse; C) The type of provider, entity or organization that committed the fraud or abuse; D) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3 E) The approximate range of dollars involved; F) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and G) Other data/information as prescribed by SDOH. iii) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. iA) The Contractor must submit quarterly, via the HPN complaint Complaint reporting format, the number of complaints Complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. iiB) The Contractor also must also submit to the SDOH the following information on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaintsComplaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etcor any other source: AI) The name of the individual or entity that committed the fraud or abuse; BII) The source that identified the fraud or abuse; CIII) The type of provider, entity or organization that committed the fraud or abuse; DIV) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; EV) The approximate range of dollars involved; FVI) The legal and administrative disposition of the case case, if available, including actions taken by law enforcement officials to whom the case has been referred; and GVII) Other data/information as prescribed by SDOHXXXX. iiiC) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. iA) The Contractor must submit quarterly, via the HPN complaint Complaint reporting format, the number of complaints Complaints of fraud or abuse made to the Contractor related to Medicaid Only Covered Services that warrant preliminary investigation by the Contractor. iiB) The Contractor must also submit to the SDOH the following on an ongoing basis for each confirmed case of fraud and or abuse it identifies through complaintsComplaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etcetc related to Medicaid Only Covered Services: A1) The name of the individual or entity that committed the fraud or abuse; B2) The source that identified the fraud or abuse; C3) The type of provider, entity or organization that committed the fraud or abuse; D4) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; E5) The approximate range dollar amount of dollars involvedthe fraud or abuse; F6) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and G7) Other data/information as prescribed by SDOHXXXX. iiiC) Such report shall be submitted when cases of fraud and or abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. i) The Contractor must submit quarterly, via the HPN complaint reporting format, the number of complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. ii) The Contractor must also submit the following information to the SDOH the following on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etc: A) The name of the individual or entity that committed the fraud or abuse; B) The source that identified the fraud or abuse; C) The type of provider, entity or organization that committed committee the fraud or abuse; D) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; E) The approximate range of dollars involved; F) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and G) Other data/information as prescribed by SDOH. iii) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. iA) The Contractor must submit quarterly, via the HPN complaint Complaint reporting format, the number of complaints Complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. iiB) The Contractor also must also submit to the SDOH the following information on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaintsComplaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etcor any other source: AI) The name of the individual or entity that committed the fraud or abuse; BII) The source that identified the fraud or abuse; CIII) The type of provider, entity or organization that committed the fraud or abuse; DIV) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; EV) The approximate range dollar amount of dollars involvedthe fraud or abuse; FVI) The legal and administrative disposition of the case case, if available, including actions taken by law enforcement officials to whom the case has been referred; and GVII) Other data/information as prescribed by SDOH.; iiiC) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer officier of the Contractor.

Fraud and Abuse Reporting Requirements. i) The Contractor must submit quarterly, via the HPN complaint reporting format, the number of complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. ii) The Contractor must also submit to the SDOH the following on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etc: A) The name of the individual or entity that committed the fraud or abuse; B) The source that identified the fraud or abuse; C) The type of provider, entity or organization that committed the fraud or abuse; D) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; E) The approximate range of dollars involved; F) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and G) Other data/information as prescribed by SDOH. iii) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. iA) The Contractor must submit quarterly, via the HPN complaint Complaint reporting format, the number of complaints Complaints of fraud or abuse made to the Contractor that warrant preliminary investigation by the Contractor. iiB) The Contractor also must also submit to the SDOH the following information on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaintsComplaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etcor any other source: AI) The name of the individual or entity that committed the fraud or abuse; BII) The source that identified the fraud or abuse; CIII) The type of provider, entity or organization that committed the fraud or abuse; DIV) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3; EV) The approximate range dollar amount of dollars involvedthe fraud or abuse; FVI) The legal and administrative disposition of the case case, if available, including actions taken by law enforcement officials to whom the case has been referred; and GVII) Other data/information as prescribed by SDOH. iiiC) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall axx xhall be reviewed and signed by an executive officer of the Contractor.

Fraud and Abuse Reporting Requirements. i) The Contractor must submit quarterly, via the HPN complaint reporting format, the number of complaints of fraud or abuse made to the Contractor that hat warrant preliminary investigation by the Contractor. ii) The Contractor must also submit to the SDOH the following on an ongoing basis for each confirmed case of fraud and abuse it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, beneficiaries, Enrollees, etc: A) The name of the individual or entity that committed the fraud or abuse; B) The source that identified the fraud or abuse; C) The type of provider, entity or organization that committed the fraud or abuse; D) A description of the fraud or abuse; SECTION 18 (CONTRACTOR REPORTING REQUIREMENTS) October 1, 2004 18-3 E) The approximate range of dollars involved; F) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and G) Other data/information as prescribed by SDOH. iii) Such report shall be submitted when cases of fraud and abuse are confirmed, and shall be reviewed and signed by an executive officer of the Contractor.