Common use of Fraud, Xxxxx, and Xxxxx Clause in Contracts

Fraud, Xxxxx, and Xxxxx. 6.1.1 Xxxxx, Waste, and Xxxxx, Generally (A) Pursuant to 42 CFR § 438.608, the Contractor or Subcontractor to the extent the Subcontractor is delegated responsibility for coverage of services and payment of Claims, shall implement and maintain arrangements or procedures, including a mandatory compliance plan, that are designed to guard against Fraud, Waste, and Abuse on the part of the Providers, Enrollees, and other patients who falsely present themselves as being Medicaid eligible. (B) The Contractor or Subcontractor shall have a written compliance plan designed to identify and refer suspected Fraud, Waste, or Abuse activities. The Contractor shall submit the compliance plan to the Department by July 1st of each year. The compliance plan shall be subject to the Department's approval. If the Department does not approve the compliance plan within 90 calendar days of receiving it, the compliance plan will be deemed approved. (C) The Contractor shall cooperate and coordinate with the Department, the Utah Office of Inspector General of Medicaid Services (Utah OIG), and MFCU in any Waste, Fraud, and Abuse activities and investigations.

Fraud, Xxxxx, and Xxxxx. 6.1.1 XxxxxFraud, Waste, and Xxxxx, Generally (A) Pursuant to 42 CFR § 438.608, the Contractor or Subcontractor to the extent the Subcontractor is delegated responsibility for coverage of services and payment of Claims, shall implement and maintain arrangements or procedures, including a mandatory compliance plan, that are designed to guard against Fraud, Waste, and Abuse on the part of the Providers, Enrollees, and other patients who falsely present themselves as being Medicaid eligible. (B) The Contractor or Subcontractor shall have a written compliance plan designed to identify and refer suspected Fraud, Waste, or Abuse activities. The Contractor shall submit the compliance plan to the Department by July 1st of each year. The compliance plan shall be subject to the Department's approval. If the Department does not approve the compliance plan within 90 calendar days of receiving it, the compliance plan will be deemed approved. (C) The Contractor shall cooperate and coordinate with the Department, the Utah Office of Inspector General of Medicaid Services (Utah OIG), and MFCU in any Waste, Fraud, and Abuse activities and investigations.