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 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.
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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 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 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. Upon review of 2019 cost reports and MCOP surveys, we adjusted the base data for the following items: ◾ Pharmacy Rebates ◾ Net Reinsurance
Sample 1Sample 2
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
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
Sample 1

Related to Third Party Liability/Fraud and Abuse

  • Third Party Liability For the purposes of the Contracts (Rights of Third Parties) Xxx 0000 this Agreement is not intended to, and does not, give any person who is not a party to it any right to enforce any of its provisions.

  • 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. 23.2 The Company will not be liable to the Client for any loss which arises as a result of: a. The Company’s compliance with, or the exercising of any of the Company’s rights in accordance with, Applicable Regulations or this Agreement; b. The Client’s negligence, fraud or breach of this Agreement or Applicable Regulations; c. Any abnormal market condition or force majeure event; d. any delays, delivery failures, or failures in transmission of any order or any other communication or any other loss or damage resulting from the transfer of data over mobile or other communications networks and facilities outside of of the Company’s control. e. Any features, market data or third party content available on the Company’s Website, Platform or e-mails, are provided on an "as is" and "if available" basis. 23.3 Neither the Company nor the directors, officers, servants, agents or representatives of the Company shall be liable to the Client (except in the case of fraud) for any consequential, indirect, special, incidental, punitive or exemplary loss, liability or cost which the Client may suffer or incur arising from the act of omissions of the Company under this Agreement regardless of how such loss, liability or cost was caused and regardless of whether it was foreseeable or not. For the purposes of this paragraph, a loss, liability or cost includes any loss, liability or cost (as appropriate) arising from the Client being unable to sell Financial Instruments where the price is falling, or from not being able to purchase Financial Instruments where the price is rising, or from being unable to enter into or complete another trade which requires him to have disposed of or purchased the Financial Instruments or any other loss, liability or cost arising as a result of loss of business, profits, goodwill or data and any indirect, special, incidental, consequential, punitive or exemplary loss, liability or cost, whether arising from negligence, breach of contract or otherwise and whether foreseeable or not. 23.4 For the avoidance of doubt, the Company’s third party providers are not responsible for and have not participated in the determination of the Company’s prices and they exclude all warranties, undertakings or representations (either express or implied) relating to the Client’s use of the Company’s Platform or the Company’s Website. Without limiting the foregoing, in no event whatsoever shall the Company’s third party providers be liable for any loss, regardless of whether they are aware of such loss and whether such liability is based on breach of contract, tort or otherwise. 23.5 Save in the event of the Company’s negligence, willful default or fraud, the Company will not be liable for any loss or damage caused by a hacker’s attack, viruses or other technologically harmful material that may infect your computer equipment, computer programs, data or other proprietary material due to your use of the Company’s Platform or Website or to the Client’s downloading of any material posted on it, or on any website (including our Website) linked to it.

  • Warranty Liability 6.1 The Seller represents and warrants that: (i) the Goods shall comply with all specifications and requirements contained in the Order or agreed in writing between the Buyer and Seller; (ii) the Goods shall be state of the art and new; (iii) the Goods shall be fit for the particular purposes that such specific Goods will usually be expected to be used for; (iv) the Goods shall be free from defects in design, materials and workmanship; (v) the Goods shall satisfactorily comply with the performance requirements expected by the Buyer; and (vi) the Goods shall meet all applicable statutory requirements and standards, especially those relating to the environment, safety and health (individually “Warranty” and collectively the “Warranties”). Any representations or warranties relating to the Goods and included in the Seller's catalogues, brochures, proposals, sales literature and quality systems or otherwise made by the Seller to the Buyer (whether verbally or in writing) shall be binding on Seller. The Seller warrants the adequacy of the technical specifications of the Order to meet the specific needs of the Buyer, and the Seller acknowledges having examined those specifications thoroughly. 6.2 The Seller warrants that all Goods sold and delivered to the Buyer (whether in terms of clause 4.1 or otherwise) are free from any lien or encumbrance of any nature whatsoever and upon delivery (whether in terms of clause 4.1 or otherwise), of the Goods to the Buyer, free and unencumbered ownership of the Goods shall pass to the Buyer upon receipt of payment for the Goods and thereafter the Buyer will be the sole owner of, and have valid and exclusive title to, the Goods. The Seller warrants further that no third party shall have any right to acquire the Goods. 6.3 The Seller warrants that the Goods will comply with the Manufacturers’ Warranty from date of delivery thereof. 6.4 If any Goods at any time are found not to comply with the Manufacturers’ Warranty, the Buyer shall be entitled, at its sole discretion, by written notice to the Seller to: (a) rescind the Order according to the provisions of clause 10 (Termination); (b) accept such Goods with a reduction in price equal to a reasonable estimate of the reduced utility of the Goods to the Buyer; or

  • University Liability The University is not responsible for any damage or injury to the Student or any other individual or property in University Housing beyond its control. The Student agrees that the University is not responsible for any damage or injury from any act of another resident or any other person. The Student agrees that the University is not responsible or liable to the Student for any personal property that is lost, stolen, or missing from University Housing. The Student shall be responsible for having adequate and appropriate insurance (i.e., homeowners supplemental insurance and/or renter’s insurance) to protect against any loss or damage to the Student’s personal property, University property and/or University Housing (e.g. fire caused by student).

  • Third Party Liability Insurance Article 30 - Discipline

  • Exceptions from Liability Without limiting the generality of any other provisions hereof, neither the Custodian nor any Domestic Subcustodian shall be under any duty or obligation to inquire into, nor be liable for:

  • Products and Completed Operations Personal Injury Liability Contractual Liability The policy shall be on an occurrence form and limits shall not be less than: $1,000,000 Each Occurrence $2,000,000 General Aggregate $1,000,000 Products/Completed Operations Aggregate $1,000,000 Personal & Advertising Injury

  • Professional Liability (Errors & Omissions Insurance with limits of not less than $1,000,000 each occurrence, $2,000,000 aggregate. Such insurance will cover all professional services rendered by or on behalf of PROVIDER and its subcontractors under this Agreement. Renewal policies written on a claims-made basis will maintain the same retroactive date as in effect at the inception of this Agreement. If coverage is written on a claims-made basis, PROVIDER agrees to purchase an Extended Reporting Period Endorsement, effective for two (2) full years after the expiration or cancellation of the policy. No professional liability policy written on an occurrence form will include a sunset or similar clause that limits coverage unless such clause provides coverage for at least three (2) years after the expiration of cancellation of this Agreement.

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