Common use of Reporting Fraud Clause in Contracts

Reporting Fraud. 6 Provider shall comply with RCW 48.135 concerning Insurance Fraud Reporting and shall 8 suspected fraud, waste, or abuse involving Services provided to an individual. Provider 9 shall report a suspected incident of fraud, waste, or abuse, including a credible allegation 10 of fraud, within five (5) business days of the date Provider first becomes aware of, or is on 11 notice of, such activity. The obligation to report suspected fraud, waste, or abuse shall 12 apply if the suspected conduct was perpetrated by Provider, Provider’s employee, agent, 13 subcontractor, or individual. Provider shall establish P&P’s for identifying, investigating 14 and taking appropriate corrective action against suspected fraud, waste, or abuse. 15 Detailed information provided to employees and subcontractors regarding fraud and 16 abuse P&P’s and the false Claims Act and the Washington false claims statutes RCW 17 Chapter 74.66 and 74.09.210. Upon request by North Sound BH-ASO and/or HCA, Provider 18 shall confer with the appropriate State agency prior to or during any investigation into 19 suspected fraud, waste, or abuse.

Reporting Fraud. 6 Provider shall comply with chapter 48.135 RCW 48.135 concerning Insurance Fraud Reporting and shall 8 notify North Sound BH-ASO Compliance Department of all incidents or occasions of suspected fraud, waste, or abuse involving Services provided to an individual. Provider 9 shall report a suspected incident of fraud, waste, or abuse, including a credible allegation 10 of fraud, within five (5) business days of the date Provider first becomes aware of, or is on 11 notice of, such activity. The obligation to report suspected fraud, waste, or abuse shall 12 apply if the suspected conduct was perpetrated by Provider, Provider’s employee, agent, 13 subcontractor, or individual. Provider shall establish P&P’s policies and procedures for identifying, investigating 14 and taking appropriate corrective action against suspected fraud, waste, or abuse. 15 Detailed information provided to employees and subcontractors regarding fraud and 16 abuse P&P’s policies and procedures and the false Claims Act and the Washington false claims statutes RCW 17 Chapter 74.66 and 74.09.210. Upon request by North Sound BH-ASO and/or HCA, Provider 18 shall confer with the appropriate State agency prior to or during any investigation into 19 suspected fraud, waste, or abuse.