Common use of Program Integrity Requirements The Contractor shall Clause in Contracts

Program Integrity Requirements The Contractor shall. 1) General Provisions a) Comply with all applicable federal and state program integrity laws and regulations regarding fraud, waste and abuse, including but not limited to, the Social Security Act and 42 CFR Parts 438, 455, and 456. b) Have adequate Massachusetts-based staffing and resources to assist the Contractor in preventing and detecting potential fraud, waste and abuse. Staff conducting program integrity activities for the Contractor shall be familiar with MassHealth and state and federal regulations on fraud, waste and abuse. c) Have written internal controls and policies and procedures in place that are designed to prevent, detect, reduce, investigate, correct and report known or suspected fraud, waste and abuse activities. d) In accordance with Section 6032 of the federal Deficit Reduction Act of 2005, make available written fraud and abuse policies to all employees. If the Contractor has an employee handbook, the Contractor shall include specific information about Section 6032, the Contractor’s policies, and the rights of employees to be protected as whistleblowers. e) Meet with EOHHS at least quarterly to discuss fraud, waste and abuse, audits, and overpayment issues. f) At EOHHS’ discretion, implement certain program integrity requirements for providers, as specified by EOHHS, including but not limited to implementing National Correct Coding Initiative edits or other CMS claims processing/provider reimbursement manuals; 2) Compliance Plan and Anti-Fraud, Waste, and Abuse Plan Have in place a Compliance Plan and Anti-Fraud, Waste, and Abuse Program Plan in accordance with this Section, copies of which shall be provided to EOHHS, in a form and format specified by EOHHS, in accordance with Appendix A, by the Contract Operational Start Date and annually thereafter. The Contractor shall make any modifications requested by EOHHS within thirty

Program Integrity Requirements The Contractor shall. 1) General Provisions a) Comply with all applicable federal and state program integrity laws and regulations regarding fraud, waste and abuse, including but not limited to, the Social Security Act and 42 CFR Parts 438, 455, and 456. b) Have adequate Massachusetts-based staffing and resources to assist the Contractor in preventing and detecting potential fraud, waste and abuse. Staff conducting program integrity activities for the Contractor shall be familiar with MassHealth and state and federal regulations on fraud, waste and abuse. c) Have written internal controls and policies and procedures in place that are designed to prevent, detectdetect , reduce, investigate, correct and report known or suspected fraud, waste and abuse activities. d) In accordance with Section 6032 of the federal Deficit Reduction Act of 2005, make available written fraud and abuse policies to all employees. If the Contractor has an employee handbook, the Contractor shall include specific information about Section 6032, the Contractor’s policies, and the rights of employees to be protected as whistleblowers. e) Meet with EOHHS at least quarterly to discuss fraud, waste and abuse, audits, and overpayment issues. f) At EOHHS’ discretion, implement certain program integrity requirements for providers, as specified by EOHHS, including but not limited to implementing National Correct Coding Initiative edits or other CMS claims processing/provider reimbursement manuals;. 2) Compliance Plan and Anti-Fraud, Waste, and Abuse Plan Have in place a Compliance Plan and Anti-Fraud, Waste, and Abuse Program Plan in accordance with this Section, copies of which shall be provided to EOHHS, in a form and format specified by EOHHS, in accordance with Appendix A, by the Contract Operational Start Date and annually thereafter. The Contractor shall make any modifications requested by EOHHS within thirtythirty (30) calendar days of a request.

Program Integrity Requirements The Contractor shall. 1) General Provisions a) Comply with all applicable federal and state program integrity laws and regulations regarding fraud, waste and abuse, including but not limited to, the Social Security Act and 42 CFR Parts 438, 455, and 456. b) Have adequate Massachusetts-based staffing and resources to assist the Contractor in preventing and detecting potential fraud, waste and abuse. Staff conducting program integrity activities for the Contractor shall be familiar with MassHealth and state and federal regulations on fraud, waste and abuse. c) Have written internal controls and policies and procedures in place that are designed to prevent, detectdetect , reduce, investigate, correct and report known or suspected fraud, waste and abuse activities. d) In accordance with Section 6032 of the federal Deficit Reduction Act of 2005, make available written fraud and abuse policies to all employees. If the Contractor has an employee handbook, the Contractor shall include specific information about Section 6032, the Contractor’s policies, and the rights of employees to be protected as whistleblowers. e) Meet with EOHHS at least quarterly to discuss fraud, waste and abuse, audits, and overpayment issues. f) At EOHHS’ discretion, implement certain program integrity requirements for providers, as specified by EOHHS, including but not limited to implementing National Correct Coding Initiative edits or other CMS claims processing/provider reimbursement manuals;. 2) Compliance Plan and Anti-Fraud, Waste, and Abuse Plan Have in place a Compliance Plan and Anti-Fraud, Waste, and Abuse Program Plan in accordance with this Section, copies of which shall be provided to EOHHS, in a form and format specified by EOHHS, in accordance with Appendix A, by the Contract Operational Start Date and annually thereafter. The Contractor shall make any modifications requested by EOHHS within thirtythirty (30) calendar days of a request.

Program Integrity Requirements The Contractor shall. 1) General Provisions a) Comply with all applicable federal and state program integrity laws and regulations regarding fraud, waste and abuse, including but not limited to, the Social Security Act and 42 CFR Parts 438, 455, and 456. b) Have adequate Massachusetts-based staffing and resources to assist the Contractor in preventing and detecting potential fraud, waste and abuse. Staff conducting program integrity activities for the Contractor shall be familiar with MassHealth and state and federal regulations on fraud, waste and abuse. c) Have written internal controls and policies and procedures in place that are designed to prevent, detect, reduce, investigate, correct and report known or suspected fraud, waste and abuse activities. d) In accordance with Section 6032 of the federal Deficit Reduction Act of 2005, make available written fraud and abuse policies to all employees. If the Contractor has an employee handbook, the Contractor shall include specific information about Section 6032, the Contractor’s policies, and the rights of employees to be protected as whistleblowers. e) Meet with EOHHS at least quarterly to discuss fraud, waste and abuse, audits, and overpayment issues. f) At EOHHS’ discretion, implement certain program integrity requirements for providers, as specified by EOHHS, including but not limited to implementing National Correct Coding Initiative edits or other CMS claims processing/provider reimbursement manuals; 2) Compliance Plan and Anti-Fraud, Waste, and Abuse Plan Have in place a Compliance Plan and Anti-Fraud, Waste, and Abuse Program Plan in accordance with this Section, copies of which shall be provided to EOHHS, in a form and format specified by EOHHS, in accordance with Appendix A, by the Contract Operational Start Date and annually thereafter. The Contractor shall make any modifications requested by EOHHS within thirtythirty (30) calendar days of a request.