Common use of RECORDS AND AUDIT PROVISIONS Clause in Contracts

RECORDS AND AUDIT PROVISIONS. ON-SITE AND OFF-SITE REVIEWS/AUDITS The PHP grants the Director, DHA or designee, the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits may be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/review includes, but is not limited to, the right to: (a) Examine fiscal and all other records of the PHP which would confirm compliance with this agreement and designation as an authorized PHP provider. (b) Conduct audits of PHP records including clinical, financial, and census records to determine the nature of the services being provided, and the basis for charges and claims against the U.S. for services provided to beneficiaries. The Director, DHA, or designee, shall have full access to records of both TRICARE and non-TRICARE patients. Note: In most cases, only TRICARE patients’ records will be audited. Examples of situations where non-TRICARE patient records would be requested may be in situations of differential quality of care assessments or to identify systemic quality or safety concerns. (c) Examine reports of evaluations and inspections conducted by federal, state, local Government, and private agencies and organizations.