Common use of Subcontracts and Provider Agreements Clause in Contracts

Subcontracts and Provider Agreements. i. The CHC-MCO must require all Network Providers and all subcontractors to take actions as are necessary to permit the CHC- MCO to comply with the Fraud, Waste, and Abuse requirements in this Agreement. ii. To the extent that the CHC-MCO delegates oversight responsibilities to a third party (such as a Pharmacy Benefit Manager), the CHC-MCO must require that such third party complies with the applicable provisions of this Agreement relating to Fraud, Xxxxx and Abuse. iii. The CHC-MCO will require, via its Provider Agreement, that Network Providers comply with MA regulations and any enforcement actions initiated by the Department under its regulations, including termination and restitution actions. iv. The CHC-MCO must suspend payment to a Network Provider when the Department determines there is a credible allegation of fraud, waste or abuse against that Network Provider, unless the Department determines there is good cause for not suspending such payments pending the investigation. v. The CHC-MCO shall require its Subcontractors to comply with the requirements set forth at 42 CFR §438.230(c)(3). vi. The CHC-MCO subcontractor agreement must specifically state that the subcontractor will grant the Department, CMS, the Pennsylvania Office of Attorney General Medicaid Fraud Control Section, HHS OIG, the Comptroller General, or their designees, access to audit, evaluate, and inspect books, records, etc., which pertain to the delivery of or payment for Medicaid services. Subcontractors must make books, records, premises, equipment, staff, etc. all available for an audit at any time. The right to inspect extends for ten (10) years after termination of contract, or conclusion of an audit, whichever is later.

Subcontracts and Provider Agreements. i. The CHC-MCO must require all Network Providers and all subcontractors to take actions as are necessary to permit the CHC- MCO to comply with the Fraud, Waste, and Abuse requirements in this Agreement. ii. To the extent that the CHC-MCO delegates oversight responsibilities to a third party (such as a Pharmacy Benefit Manager), the CHC-MCO must require that such third party complies with the applicable provisions of this Agreement relating to Fraud, Xxxxx and Abuse. iii. The CHC-MCO will require, via its Provider Agreement, that Network Providers comply with MA regulations and any enforcement actions initiated by the Department under its regulations, including termination and restitution actions. iv. The CHC-MCO must suspend payment to a Network Provider when the Department determines there is a credible allegation of fraud, waste or abuse fraud against that Network Provider, unless the Department determines there is good cause for not suspending such payments pending the investigation. v. The CHC-MCO shall require its Subcontractors to comply with the requirements set forth at 42 CFR §438.230(c)(3). vi. The CHC-MCO subcontractor agreement must specifically state that the subcontractor will grant the Department, CMS, the Pennsylvania Office of Attorney General Medicaid Fraud Control Section, HHS OIG, the Comptroller General, or their designees, access to audit, evaluate, and inspect books, records, etc., which pertain to the delivery of or payment for Medicaid services. Subcontractors must make books, records, premises, equipment, staff, etc. all available for an audit at any time. The right to inspect extends for ten (10) years after termination of contract, or conclusion of an audit, whichever is later.

Subcontracts and Provider Agreements. i. The CHC-MCO must require all Network Providers and all subcontractors to take actions as are necessary to permit the CHC- MCO to comply with the Fraud, Waste, and Abuse requirements in this Agreement. ii. To the extent that the CHC-MCO delegates oversight responsibilities to a third party (such as a Pharmacy Benefit Manager), the CHC-MCO must require that such third party complies with the applicable provisions of this Agreement relating to Fraud, Xxxxx Waste and Abuse. iii. The CHC-MCO will require, via its Provider Agreement, that Network Providers comply with MA regulations and any enforcement actions initiated by the Department under its regulations, including termination and restitution actions. iv. The CHC-MCO must suspend payment to a Network Provider when the Department determines there is a credible allegation of fraud, waste or abuse fraud against that Network Provider, unless the Department determines there is good cause for not suspending such payments pending the investigation. v. The CHC-MCO shall require its Subcontractors to comply with the requirements set forth at 42 CFR §438.230(c)(3). vi. The CHC-MCO subcontractor agreement must specifically state that the subcontractor will grant the Department, CMS, the Pennsylvania Office of Attorney General Medicaid Fraud Control Section, HHS OIG, the Comptroller General, or their designees, access to audit, evaluate, and inspect books, records, etc., which pertain to the delivery of or payment for Medicaid services. Subcontractors must make books, records, premises, equipment, staff, etc. all available for an audit at any time. The right to inspect extends for ten (10) years after termination of contract, or conclusion of an audit, whichever is later.