Fraud and Abuse Requirements. The Contractor shall report in writing all verified cases of fraud and abuse, including fraud and abuse by the Contractor’s employees and/or subcontractors, within five (5) business days, to the HCA Contact designated on page one of this Contract. The report shall include the following information:
a. Subject(s) of complaint by name and either provider/subcontractor type or employee position;
b. Source of complaint by name and provider/subcontractor type or employee position;
c. Nature of compliant;
d. Estimate of the amount of funds involved; and
e. Legal and administrative disposition of case.
Fraud and Abuse Requirements. The Contractor shall report in writing all verified cases of fraud and abuse, including fraud and abuse by the Contractor’s employees and/or Subcontractors, within five (5) Business Days, to the HCA Contract Manager designated on page one of this Contract. The report shall include the following information:
32.1. Subject(s) of complaint by name and either provider/Subcontractor type or employee position;
32.2. Source of complaint by name and provider/Subcontractor type or employee position;
32.3. Nature of compliant;
32.4. Estimate of the amount of funds involved; and
32.5. Legal and administrative disposition of case.
Fraud and Abuse Requirements.
29.1 Subject(s) of complaint by name and either provider/subcontractor type or employee position;
29.2 Source of complaint by name and provider/subcontractor type or employee position;
29.3 Nature of complaint;
29.4 Estimate of the amount of funds involved; and
29.5 Legal and administrative disposition of case. 30 Governing Law
Fraud and Abuse Requirements. The Contractor shall have and follow the Fraud and Abuse requirements described in this section.
12.3.1. The Contractor’s policies and procedures related to fraud and abuse shall include compliance with 42 CFR 438.608(a) and section 1902(a)(68) of the Social Security Act and include the requirement of compliance of staff and subcontractors with the requirements described in this section.
12.3.2. The Contractor shall have:
12.3.2.1. In effect a process to inform employees and subcontractors regarding the False Claims Act.
12.3.2.2. Administrative and management arrangements or procedures, and a mandatory compliance plan.
12.3.2.3. Standards of conduct that articulates the Contractor’s commitment to comply with all applicable federal and state standards.
12.3.2.4. The designation of a compliance officer and a compliance committee that is accountable to senior management.
12.3.2.5. Effective training for the compliance officer and the Contractor’s employees and subcontractors.
12.3.2.6. Effective lines of communication between the compliance officer and the Contractor’s staff and subcontractors.
12.3.2.7. Enforcement of standards through well-publicized disciplinary guidelines.
12.3.2.8. Provision for internal monitoring and auditing.
12.3.2.9. Provision for prompt response to detected offenses, and for development of corrective action initiatives.
12.3.2.10. Provision of detailed information to employees and subcontractors regarding fraud and abuse policies and procedures and the False Claims Act as identified in Section 1902(a)(68) of the Social Security Act.
12.3.3. The Contractor shall report in writing to DSHS all verified cases of fraud and abuse, including fraud and abuse by the Contractor’s employees and subcontractors, within seven (7) calendar days according to the Notices provisions of the General Terms and Conditions Section of this Contract. The report shall include the following information:
12.3.3.1. Subject(s) of complaint by name and either provider/subcontractor type or employee position.
12.3.3.2. Source of complaint by name and provider/subcontractor type or employee position, if applicable.
12.3.3.3. Nature of complaint.
12.3.3.4. Estimate of the amount of funds involved.
12.3.3.5. Legal and administrative disposition of case.
Fraud and Abuse Requirements. The Contractor shall report in writing all verified cases of fraud and abuse, including fraud and abuse by the Contractor’s employees and/or subcontractors, within five (5) business days, to the HCA Contact designated on page one of this Contract. The report shall include the following information: • Subject(s) of complaint by name and either provider/subcontractor type or employee position; • Source of complaint by name and provider/subcontractor type or employee position; • Nature of compliant; • Estimate of the amount of funds involved; and • Legal and administrative disposition of case This Contract shall be construed and interpreted in accordance with the laws of the state of Washington and the venue of any action brought hereunder shall be in Superior Court for Xxxxxxxx County.
Fraud and Abuse Requirements. The Contractor shall report in writing all verified cases of fraud and abuse, including fraud and abuse by the Contractor’s employees and/or subcontractors, within five (5) business days, to the HCA Contact designated on page one (1) of this Contract. The report shall include the following information:
Fraud and Abuse Requirements. 94 Section 9.14.1. Fraud and Abuse by HEALTH PLAN and/or its Subcontractor. 94 Section 9.14.2. Fraud and Abuse by Recipients 94
Fraud and Abuse Requirements. Section 9.14.1.
Fraud and Abuse Requirements. The MAC contractor must report in writing all verified cases of fraud and abuse, including fraud and abuse by the MAC contractor’s employees or subcontractor or both, within five (5) business days, to the HCA contact designated on page one of the agreement. The report shall include the following information:
29.1 Subject(s) of complaint by name and either provider/subcontractor type or employee position;
29.2 Source of complaint by name and provider/subcontractor type or employee position;
29.3 Nature of complaint;
29.4 Estimate of the amount of funds involved; and
29.5 Legal and administrative disposition of case.
Fraud and Abuse Requirements. The Contractor shall report in writing all verified cases of fraud and abuse, including fraud and abuse by the Contractor’s employees and/or subcontractors, within five (5) business days, to the Lewis County contact designated on page one of this Contract. The report shall include the following information:
i. Subject(s) of complaint by name and either provider/subcontractor type or employee position;
ii. Source of complaint by name and provider/subcontractor type or employee position;
iii. Nature of compliant;
iv. Estimate of the amount of funds involved; and
v. Legal and administrative disposition of case.
