Medicare Compliance. PBM shall, and shall require PBM Contracting Providers to, comply with all applicable Medicare laws and regulations and HCFA instructions.
Medicare Compliance. Residents who choose to engage in external 36 moonlighting must perform such activities in compliance with government 37 healthcare program laws and regulations, including regulations regarding 38 payment for physician services under the Medicare program. The University 39 of Washington is not responsible for ensuring that Residents who choose to 40 externally moonlight are in compliance with these laws and regulations 41 despite the fact that an external moonlighting activity may have been 42 approved by the Program Director.
Medicare Compliance. Provider shall comply with all applicable Medicare laws, regulations, and CMS instructions. (42 CFR 422.504(i)(4)(v)).
Medicare Compliance. Provider agrees to require all of its downstream, related entity(s) and transferees to comply with all applicable Medicare laws, regulations, and CMS instructions. (42 CFR 422.504(i)(4)(v).)
Medicare Compliance. Provider will comply with all federal and state laws, regulations, and CMS instructions.
Medicare Compliance. Employee agrees to comply with all applicable Medicare laws, regulations, and Centers for Medicare & Medicaid Services (“CMS”) instructions, including but not limited to the following:
(a) The U.S. Department of Health & Human Services (“HHS”), the Comptroller General, or their designees have the right to inspect, evaluate, and audit any pertinent contracts, books, documents, papers, and records involving transactions related to a Medicare contract for a period of 10 years from the final date of the contract or the completion of any audit, whichever is later;
(b) Employee will safeguard beneficiary privacy and confidentiality and assure the accuracy of beneficiary health records;
(c) Employee may not hold beneficiaries liable for payment of fees that are the legal obligation of an applicable Medicare Advantage Organization;
(d) Services performed by Employee will comply with an applicable Medicare Advantage Organization’s policies and procedures, as well as with obligations CMS imposes upon the Medicare Advantage Organization;
(e) Services performed by the Employee that are pertinent to a contract with a Medicare Advantage Organization may be monitored by the Medicare Advantage Organization on an ongoing basis;
(f) The credentials of Employee may be (i) reviewed by the Medicare Advantage Organization; (ii) or the credentialing process may be reviewed and approved by the Medicare Advantage Organization, (iii) OR the Medicare Advantage Organization may audit the credentialing process on an ongoing basis;
(g) Employee will comply with Medicare fraud and abuse plan requirements; and
(h) Employee will cooperate with the applicable Medicare Advantage Organization’s process of complaints or grievances, quality improvement programs, requests to change providers, and analyses of enrollee satisfaction surveys and other sources of enrollee input.
Medicare Compliance. With respect to the SNF Facility, to the Seller's actual knowledge:
(i) All material reports, documents and notices including without limitation all Medicare cost reports required to be filed, maintained or furnished by Seller to any governmental agency by such Facility have been so filed, maintained or furnished, and all such reports, documents and notices were complete and correct in all material respects on the date filed (or were corrected in or supplemented by a subsequent filing) such that no liability exists with respect to such filing;
(ii) Such Facility is eligible to receive payment under Title XVIII of the Social Security Act and under Title XIX of such Act, and there are no actions, appeals or investigations pending or threatened before any entity, commission, board or agency, including an intermediary or carrier or the Administrator of the Health Care Financing Administration, with respect to any Medicare claims or reports filed by such Facility on or before the date hereof or program compliance matters, which would reasonably be expected to have a material adverse effect on the operation of the Facility;
(iii) Other than regularly scheduled audits and reviews, no validation review, peer review or program integrity review related to such Facility has been conducted by any entity, commission, board or agency in connection with the Medicare program, and no such reviews are scheduled, pending or threatened against or affecting the business; and
(iv) None of Seller, or the officers, directors or managing employees or other employees or agents of Seller engaged in any activities which are prohibited under criminal law, or are cause for civil penalties or mandatory or permissive exclusion from Medicare, or any other state health care program or federal health care program under Sections 1320a-7, 1320a-7a, 1320a-7b or 1395nn of Title ___ of the United States Code, or the regulations promulgated pursuant to such statutes or regulations or related state or local statutes.
Medicare Compliance. VENDOR agrees:
A. All Services shall be performed in compliance with applicable Federal and State laws, regulations, CMS issuances and directives governing Plans and Plan requirements; including by not limited to Medicare statutes and provisions of the Social Security Act, CMS reporting requirements and instructions, CMS Guidelines, Policies, Procedures, Manuals, Operations Instructions, and any other applicable CMS guidance or instructions (collectively, “CMS Requirements”), and this Addendum is automatically amended to include any CMS Requirements affecting the Agreement as of the date such CMS Requirement becomes effective, without regard to whether HMO provides notice or copies of such CMS Requirements to VENDOR;
B. All Services shall be performed in compliance with HMO’s contractual obligations to CMS, and VENDOR understands and acknowledges that by agreeing to provide the Services under this Agreement, it is agreeing to participate in the service and/or delivery of Plan benefits and that payment for such services are, in whole or in part, from Federal funds;
C. It will abide by all applicable Federal and State laws and regulations and CMS Requirements including, but not limited to, applicable provisions of Federal criminal law, the False Claims Act (31 USC 3729 et seq.), anti-kickback statues (Social Security XXX § 0000X), Health Insurance Portability and Accountability Act administration simplification rules at 45 CFR parts 160, 162, and 164; and HMO’s instructions and policies and procedures including Operations Procedures;
D. It will abide by State and Federal privacy and security requirements, including the privacy and security provisions of Health Insurance Portability and Accountability Act of 1996 and the New Jersey Information Practices Act and other applicable New Jersey and other State law and regulation;
E. It will provide access to its facilities, and equipment, and make its books and other records pertaining to the Services and to CMS’ contract with Plan sponsor available to HMO, CMS, the Department of Health and Human Services, the Office of the Comptroller General, General Accounting Office, the Office of the Inspector General (“OIG”) and/or their respective designees, at no cost to HMO; and that these rights continue for a period of 10 years from the final date of the contract period, or longer if CMS determines the need, or the date of audit completion, whichever is later. Such time may be extended for up to 6 years from the date of ...
Medicare Compliance. Physician shall comply with and is subject to all applicable Medicare program rules and regulations as implemented and as amended by the Health Care Financing Administration ("HCFA"), including without limitation Humana's and federal and state regulatory agencies' rights to audit Physician's operations, books, records and other documentation related to Physician's obligations under the Agreement, as well as all other federal and state laws, rules and regulations applicable to individuals and entities receiving federal funds, including without limitation Title VI of The Civil Rights Act of 1964, The Age Discrimination Act of 1975, The Americans With Disabilities Act and The
