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

Fraud, Xxxxx, and Xxxxx. 6.1.1 Xxxxx, Wast, 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 maintan 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 shall have a written compliance plan designed to identify and refer suspected Fraud, Waste, and Abuse activities. The Contractor shall submit the compliance plan to the Department by July 1st of each year for the Department’s review and approval. If the Department does not respond with approval within 90 calendar days of the compliance plan due date, the plan will be deemed approved. (C) The Contractor’s compliance plan shall include a description of the Contractor’s Fraud, Waste, and Abuse case management tracking system. If the Contractor does not have a Fraud, Waste, and Abuse case management tracking system the Contractor shall describe its plans to develop such a tracking system. (D) The Contractor’s compliance plans shall designate the staff members and other resources being allocated to the prevention, detection, investigation and referral of suspected Provider Fraud, Waste, and Xxxxx. (E) The Contractor’s compliance plans shall include a description of the Contractor’s payment suspension process and how this process is in compliance with Article 6.

Fraud, Xxxxx, and Xxxxx. 6.1.1 Xxxxx, WastWaste, 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 maintan 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 shall have a written compliance plan designed to identify and refer suspected Fraud, Waste, and Abuse activities. The Contractor shall submit the compliance plan to the Department by July 1st of each year for the Department’s review and approval. If the Department does not respond with approval within 90 calendar days of the compliance plan due date, the plan will be deemed approved. (C) The Contractor’s compliance plan shall include a description of the Contractor’s Fraud, Waste, and Abuse case management tracking system. If the Contractor does not have a Fraud, Waste, and Abuse case management tracking system the Contractor shall describe its plans to develop such a tracking system. (D) The Contractor’s compliance plans shall designate the staff members and other resources being allocated to the prevention, detection, investigation and referral of suspected Provider Fraud, Waste, and Xxxxx. (E) The Contractor’s compliance plans shall include a description of the Contractor’s payment suspension process and how this process is in compliance with Article 6.