Referral to the Department Sample Clauses

Referral to the Department. The PH-MCO must establish a policy on referral of suspected Fraud and Abuse to the Department. A standardized referral process is outlined in Exhibit KK of this Agreement, Reporting Suspected Fraud and Abuse to the Department, to expedite information for appropriate disposition.
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Referral to the Department. The CHC-MCO must establish and implement a policy on referral of suspected Provider Fraud, Waste and Abuse to the Department. A standardized referral process is outlined in Exhibit Q, Reporting Suspected Fraud, Waste, and Abuse to the Department.
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Referral to the Department. The CHIP-MCO must establish a policy for prompt, as defined in Exhibit U, referral of suspected Fraud, Waste and Abuse to the Department and the Pennsylvania Office of Attorney General, Medicaid Fraud Control Section as required in 42 CFR §457.1285 referencing 42 CFR§438.608(a)(7). A standardized referral process is outlined in Exhibit U of this Agreement, Reporting Suspected Fraud, Xxxxx and Abuse to the Department. The CHIP-MCO must report to the Department and to the Pennsylvania Office of Attorney General Medicaid Fraud Control Section all cases of suspected fraud, waste, or abuse, in the manner specified by the Department. If a CHIP-MCO fails to promptly report a case of suspected fraud or abuse before the suspected fraud or abuse is identified by the Commonwealth of Pennsylvania, its designees, the United States or private parties acting on behalf of the United States, any portion of the fraud or abuse recovered by the Commonwealth of Pennsylvania or designee shall be retained by the Commonwealth of Pennsylvania or its designees.
Sample 1
Referral to the Department. The CHC-MCO must establish and implement a policy on the referral of a suspected Provider or Direct Care Worker of Fraud, Waste and Abuse to the Department and the Pennsylvania Office of Attorney General, Medicaid Fraud Control Section. A standardized referral process is outlined in Exhibit Q, Reporting Suspected Fraud, Waste, and Abuse to the Department and the Pennsylvania Office of Attorney General Medicaid Fraud Control Section. The CHC-MCO must promptly report all cases of suspected fraud, waste, and abuse as specified by the Department in Exhibit Q. If a CHC-MCO fails to promptly report a case of suspected fraud or abuse before the suspected fraud or abuse is identified by the Commonwealth of Pennsylvania, its designees, the United States or private parties acting on behalf of the United States, any portion of the fraud or abuse recovered by the Commonwealth of Pennsylvania or designee shall be retained by the Commonwealth of Pennsylvania or its designees.
Sample 1
Referral to the Department. The PH-MCO must establish a policy for referral of suspected Fraud, Waste and Abuse to the Department as required in 42 CFR §438.608(a)(7). A standardized referral process is outlined in Exhibit KK of this Agreement, Reporting Suspected Fraud, Waste and Abuse to the Department, to expedite information for appropriate disposition. The PH-MCO must promptly report to the Department all cases of suspected fraud, waste or abuse, in the manner specified by the Department. If a PH-MCO fails to promptly report a case of suspected fraud or abuse before the suspected fraud or abuse is identified by the Commonwealth of Pennsylvania, its designees, the United States or private parties acting on behalf of the United States, any portion of the fraud or abuse recovered by the Commonwealth of Pennsylvania or designee shall be retained by the Commonwealth of Pennsylvania or its designees.
Sample 1
Referral to the Department. The CHC-MCO must establish and implement a policy on the referral of a suspected Provider or Direct Care Worker of Fraud, Waste and Abuse to the Department. A standardized referral process is outlined in Exhibit Q, Reporting Suspected Fraud, Waste, and Abuse to the Department and the Office of Attorney General. If a CHC-MCO fails to promptly report a case of suspected fraud or abuse before the suspected fraud or abuse is identified by the Commonwealth of Pennsylvania, its designees, the United States or private parties acting on behalf of the United States, any portion of the fraud or abuse recovered by the Commonwealth of Pennsylvania or designee shall be retained by the Commonwealth of Pennsylvania or its designees.
Sample 1

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