Third Party Liability/Fraud and Abuse Sample Clauses

Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2018 cost reports and MCP surveys. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs.
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Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in calendar year 2014 cost report and MCP surveys. These data sources indicated that approximately 0.55% total claims were recovered and not reflected in the baseline experience data. We separately adjusted cost report and encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs. 6 xxxx://xxx.xxxxx.xxxxx.xx.xx/lpc/calendar/fileLINKNAME.asp?ID=MHTL3334-14-04 7 xxxx://xxx.xxxxx.xxxxx.xx.xx/lpc/calendar/fileLINKNAME.asp?ID=MHTL3334-15-01 8 xxxx://xxxxx.xxxx.xxx/oac/5160-2-21 9 xxxx://xxxxxxxx.xxxx.xxx/FOROHIOANS/AlreadyCovered/MedicaidCopays.aspx
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Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2016 cost report and MCP surveys. These data sources indicated that approximately 0.3% of total claims were recovered and not reflected in the baseline experience data. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs. For the AFK population, we assumed an amount of TPL/Fraud and Abuse recoveries consistent with reported values for the CFC and ABD child populations.
Sample 1Sample 2
Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in calendar year 2014 cost report and MCP surveys. These data sources indicated that approximately 0.55% total claims were recovered and not reflected in the baseline experience data. We separately adjusted cost report and encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs. 6 xxxx://xxx.xxxxx.xxxxx.xx.xx/lpc/calendar/fileLINKNAME.asp?ID=MHTL3334-14-04 7 xxxx://xxx.xxxxx.xxxxx.xx.xx/lpc/calendar/fileLINKNAME.asp?ID=MHTL3334-15-01 8 xxxx://xxxxx.xxxx.xxx/oac/5160-2-21 9 xxxx://xxxxxxxx.xxxx.xxx/FOROHIOANS/AlreadyCovered/MedicaidCopays.aspx Net Reinsurance Ohio Administrative Code requires MCPs contracted with ODM for the MMC program to carry reinsurance for high cost inpatient claims. We have adjusted inpatient expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the 2014 annual cost report data. The aggregate statewide reinsurance loss ratio for MCPs in 2014 was approximately 79% (reinsurance recoveries / reinsurance premiums). A statewide estimated reinsurance premium by rate cell was developed by taking statewide reinsurance recoveries for each rate cell and dividing by the 79% loss ratio. The statewide rate cell reinsurance premium estimates were further adjusted based on estimated regional reinsurance loss ratios. Reinsurance recoveries were based on amounts reported in MCP cost report data. While we have not changed the aggregate amount of MMC reinsurance premiums reported, we believe these adjustments allocate the reinsurance premium on a more actuarial sound basis at the rate cell level.
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Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2019 cost reports and MCOP surveys. Incarcerated Recipients Incarcerated individuals are not eligible for the MyCare program. These individuals are either flagged in the eligibility data or in the claims data as individuals receiving care in a prison or correctional facility. Adjustments made to base data Upon review of 2019 cost reports and MCOP surveys, we adjusted the base data for the following items: ◾ Pharmacy Rebates ◾ Net Reinsurance
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Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the cost report data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2016 cost report and MCOP surveys. These data sources indicated that approximately 0.2% total claims were recovered and not reflected in the baseline experience data. Because the cost report claims data is gross of TPL and fraud recoveries, we adjusted the cost report base data to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCOPs.
Sample 1

Related to Third Party Liability/Fraud and Abuse

  • Third Party Liability The following shall apply to all employees: Effective Sunday after ratification, should an employee receive Overwaitea Foods Weekly Indemnity Benefits as the result of an accident and they subsequently receive a wage loss settlement from I.C.B.C. covering the same period, the amount by which Weekly Indemnity Benefits and Sick Leave Benefits cause the total replacement income to exceed the employee's regular earnings shall be reimbursed to the Employer. Any banked sick days which may have been used shall be returned to the employee's banked sick days' accumulation. The parties agree to request the Trustees to adopt a new reimbursement policy, with respect to Third Party Liabilities.

  • PARTY LIABILITY Contractor’s total liability under this Agreement, whether for breach of contract, warranty, negligence, strict liability, in tort or otherwise, is limited to the price of the particular products/services sold hereunder. Contractor agrees either to refund the purchase price or to repair or replace product(s) that are not as warranted. Contractor accepts liability to repay, and shall repay upon demand to END USER, any amounts determined by H-GAC, its independent auditors, or any state or federal agency, to have been paid in violation of the terms of this Agreement.

  • Indemnity/Liability You shall indemnify, and hold harmless RIM, the RIM Group of Companies, RIM's affiliates, suppliers, successors, agents, authorised distributors, (including Airtime Service Providers) and assigns and each of their directors, officers, employees and independent contractors (each a "RIM Indemnified Party") from any damages, losses, costs or expenses (including reasonable lawyers’ fees and costs) incurred by a RIM Indemnified Party, and at the RIM Indemnified Party’s request defend at Your expense any third party claim or proceeding brought against the RIM Indemnified Party, arising from: (a) infringement of patents or other intellectual property or proprietary rights arising from combining with or using any device (other than a BlackBerry Handheld Product), system or service in connection with Your BlackBerry Solution or any portion thereof; or (b) Your breach of this Agreement or any Addendum to this Agreement. No remedy herein conferred upon RIM is intended to be, nor shall it be construed to be, exclusive of any other remedy provided herein or as allowed by law or in equity, but all such remedies shall be cumulative.

  • Company Liability 23.1 Nothing in this Agreement excludes or limits the Company’s liability for any matter that cannot be excluded or limited under Applicable Regulations.

  • Warranty/Liability 4.1 UP42 warrants that it has sufficient ownership rights in the PRODUCT to make the PRODUCT available to the LICENSEE under the terms hereof.

  • INSURANCE AND LIABILITIES TO THIRD PARTIES 8.1 The Contractor shall provide and thereafter maintain insurance against all risks in respect of its property and any equipment used for the execution of this Contract.

  • Third Party Liability Insurance (w) Article 30 - Discipline

  • Indemnification Against Third-Party Claims Each Party (the Indemnifying Party) agrees to indemnify, defend, and hold harmless the other Party (the Indemnified Party) and the other Party’s Subsidiaries, predecessors, successors, Affiliates, and assigns, and all current and former officers, directors, members, shareholders, agents, contractors and employees of all such persons and entities (collectively, with Indemnified Party, the “Indemnitee Group”), from any and all Claims (as hereinafter defined).

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