FRAUDULENT PRACTICES. A “Fraudulent Practice” is any action or omission, including misrepresentation, that knowingly or recklessly misleads, or attempts to mislead, a person to obtain a financial benefit or to avoid an obligation.
FRAUDULENT PRACTICES. HMO must report all fraud and abuse enforcement actions or investigations taken against HMO and/or any of its subcontractors or providers by any state or federal agency for fraud or abuse under Title XVIII or Title XIX of the Social Security Act or any State law or regulation and any basis upon which an action for fraud or abuse may be brought by a State or federal agency as soon as such information comes to the attention of HMO.
FRAUDULENT PRACTICES. Report - Utilizing the HHSC-Office of Inspector General (OIG) fraud referral form, the HMO’s assigned officer or director must report and refer all possible acts of waste, abuse or fraud to the HHSC-OIG within 30 working days of receiving the reports of possible acts of waste, abuse or fraud from the HMO’s Special Investigative Unit (SIU). The report and referral must include: an investigative report identifying the allegation, statutes/regulations violated or considered, and the results of the investigation; copies of program rules and regulations violated for the time period in question; the estimated overpayment identified; a summary of the interviews conducted; the encounter data submitted by the provider for the time period in question; and all supporting documentation obtained as the result of the investigation. This requirement applies to all reports of possible acts of waste, abuse and fraud. Additional reports required by the Office of the Inspector General relating to waste, abuse or fraud are listed in the HHSC Uniform Managed Care Manual.
FRAUDULENT PRACTICES. 103 12.8 UTILIZATION MANAGEMENT REPORTS - BEHAVIORAL HEALTH................ 103 12.9 UTILIZATION MANAGEMENT REPORTS - PHYSICAL HEALTH.................. 103 12.10
FRAUDULENT PRACTICES. It is a fraudulent practice and it is unlawful:
FRAUDULENT PRACTICES. 3.1 The Agencyrequires compliance with its policy in regard to corrupt and fraudulent practices as set forth in Section VI.
FRAUDULENT PRACTICES. 111 -------------------- 12.8 UTILIZATION MANAGEMENT REPORTS - BEHAVIORAL HEALTH.............................................111 -------------------------------------------------- 12.9 UTILIZATION MANAGEMENT REPORTS - PHYSICAL HEALTH...............................................111 ------------------------------------------------ 12.10 QUALITY IMPROVEMENT REPORTS....................................................................111 --------------------------- 12.11
FRAUDULENT PRACTICES. 2 The “World Bank” is the International Bank for Reconstruction and Development, an international organization established by Articles of Agreement among its member countries and the “World Bank Group” refers to the International Bank for Reconstruction and Development, the International Development Association, the International Finance Corporation, the Multilateral Investment Guarantee Agency, and the International Centre for Settlement of Investment Disputes. Annex A Page 2 of 3 A “Fraudulent Practice” is any action or omission, including a misrepresentation, that knowingly or recklessly misleads, or attempts to mislead, a party to obtain a financial or other benefit or to avoid an obligation.
FRAUDULENT PRACTICES. 97 12.8 UTILIZATION MANAGEMENT REPORTS - BEHAVIORAL HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 12.9 UTILIZATION MANAGEMENT REPORTS - PHYSICAL HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 12.10
FRAUDULENT PRACTICES. 91 12.8 UTILIZATION MANAGEMENT REPORTS - BEHAVIORAL HEALTH...91 12.9 UTILIZATION MANAGEMENT REPORTS - PHYSICAL HEALTH.....92 12.10 UTILIZATION MANAGEMENT REPORTS - LONG TERM CARE......92 12.11
