REASONS FOR RECOUPMENT Sample Clauses

REASONS FOR RECOUPMENT. 23.1. COUNTY will conduct periodic audits of CONTRACTOR files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and COUNTY regulations. 23.2. Such audits may result in requirements for CONTRACTOR to reimburse COUNTY for services previously paid in the following circumstances: 23.2.1. Identification of Fraud, Waste or Abuse as defined in federal regulation 23.2.1.1. Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, section 14107.11, subdivision (d).

REASONS FOR RECOUPMENT. 4.6.1. COUNTY will conduct periodic audits of CONTRACTOR files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and COUNTY regulations. 4.6.2. Such audits may result in requirements for CONTRACTOR to reimburse COUNTY for services previously paid in the following circumstances: 4.6.2.1. Identification of Fraud, Waste or Abuse as defined in federal regulation.

REASONS FOR RECOUPMENT. 30.1. COUNTY will conduct periodic audits of CONTRACTOR files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and COUNTY regulations. 30.2. Such audits may result in requirements for CONTRACTOR to reimburse COUNTY for services previously paid in the following circumstances: 30.2.1. Identification of Fraud, Waste or Abuse as defined in federal regulation. • Fraud and abuse are defined in Code of Federal Regulations, Title 42, § 455.2 and Welfare & Institutions Code, § 14107.11, subdivision (d). • Definitions for “fraud,” “waste,” and “abuse” can also be found in the Medicare Managed Care Manual available at xxx.xxx.xxx/Xxxxxxxxxxx-xxx- Guidance/Guidance/Manuals/Downloads/mc86c21.pdf.

REASONS FOR RECOUPMENT. A. County will conduct periodic audits of Contractor files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and county regulations. B. Such audits may result in requirements for Contractor to reimburse County for services previously paid in the following circumstances: I. Identification of Fraud, Waste or Abuse as defined in federal regulation. a. Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, section 14107.11, subdivision (d). b. Definitions for “fraud,” “waste,” and “abuse” can also be found in the Medicare Managed Care Manual available at: II. Overpayment of Contractor by County due to errors in claiming or documentation. III. Other reasons specified in the SMHS Reasons for Recoupment document released annually by DHCS and posted on the DHCS BHIN website. C. Contractor shall reimburse County for all overpayments identified by Contractor, County, and/or state or federal oversight agencies as an audit exception within the timeframes required by law or Country or state or federal agency.

REASONS FOR RECOUPMENT. A. County will conduct periodic audits of Contractor files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and county regulations. B. Such audits may result in requirements for Contractor to reimburse County for services previously paid in the following circumstances: I. Identification of Fraud, Waste or Abuse as defined in federal regulation. a. Fraud and abuse are defined in Code of Federal Regulations, Title 42, § 455.2 and Welfare & Institutions Code, § 14107.11, subdivision (d). b. Definitions for “fraud,” “waste,” and “abuse” can also be found in the Medicare Managed Care Manual available at xxx.xxx.xxx/Xxxxxxxxxxx-xxx- Guidance/Guidance/Manuals/Downloads/mc86c21.pdf. II. Overpayment of Contractor by County due to errors in claiming or documentation. C. Contractor shall reimburse County for all overpayments identified by Contractor, County and/or state or federal oversight agencies as an audit exception within the timeframes required by law or Country or state or federal agency.

REASONS FOR RECOUPMENT. A. County will conduct periodic audits of Contractor files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and county regulations. B. Such audits may result in requirements for Contractor to reimburse County for services previously paid in the following circumstances: I. Identification of Fraud, Waste or Abuse as defined in federal regulation. a. Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and WsI Code, section 14107.11, subdivision (d). b. Definitions for “fraud,” “waste,” and “abuse” can also be found in the Medicare Managed Care Manual available at xxx.xxx.xxx/Xxxxxxxxxx-xxx- Guidance/Guidance/Manuals/Downloads/mc86c21.pdf II. Overpayment of Contractor by County due to errors in claiming or documentation. III. Other reasons specified in the SMHS Reasons for Recoupment document released annually by DHCS and posted on the DHCS BHIN website. C. Contractor shall reimburse County for all overpayments identified by Contractor, County, and/or state or federal oversight agencies as an audit exception within the timeframes required by law or Country or state or federal agency.

REASONS FOR RECOUPMENT. COUNTY will conduct periodic audits of CONTRACTOR files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and COUNTY regulations. Such audits may result in requirements for CONTRACTOR to reimburse COUNTY for services previously paid in the following circumstances: 15.6.1. Identification of Fraud, Waste or Abuse as defined in federal regulation. 15.6.1.1. Fraud and abuse are defined in Code of Federal Regulations, Title 42, § 455.2 and Welfare & Institutions Code, § 14107.11, subdivision (d). 15.6.1.2. Definitions for “fraud,” “waste,” and “abuse” can also be found in the Medicare Managed Care Manual available at xxx.xxx.xxx/Xxxxxxxxxxx- and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf.

REASONS FOR RECOUPMENT. 30.1. COUNTY will conduct periodic audits of CONTRACTOR files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and COUNTY regulations. 30.2. Such audits may result in requirements for CONTRACTOR to reimburse COUNTY for services previously paid in the following circumstances: 30.2.1. Identification of Fraud, Waste or Abuse as defined in federal regulation. 30.2.1.1. Fraud and abuse are defined in Code of Federal Regulations, Title 42, § 455.2 and Welfare & Institutions Code, § 14107.11, subdivision (d). 30.2.1.2. Definitions for “fraud,” “waste,” and “abuse” can also be found in the Medicare Managed Care Manual available at xxx.xxx.xxx/Xxxxxxxxxxx- and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf.

REASONS FOR RECOUPMENT. A. COUNTY will conduct periodic audits of CONTACTOR files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and county regulations. B. Such audits may result in requirements for CONTRACTOR to reimburse COUNTY for services previously paid in the following circumstances: I. Identification of Fraud, Waste or Abuse as defined in federal regulation a. Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, section 14107.11, subdivision (d).