Xxxxx, Xxxxx and Abuse; Ethical Conduct Sample Clauses

Xxxxx, Xxxxx and Abuse; Ethical Conduct. Contractor shall maintain and enforce policies, procedures, processes, systems, and internal controls (i) to reduce fraud, waste, and abuse, and (ii) to enhance compliance with other applicable laws, rules, and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that meets the requirements of applicable laws, rules, and regulations. Contractor shall provide evidence of such compliance program as reasonably requested by Covered California. Contractor shall timely communicate to Covered California any material concerns identified by Contractor or by State and Federal Regulators related to regulatory compliance that may impact performance under this Agreement. Contractor shall provide Covered California with a description of its fraud, waste, and abuse detection and prevention programs and report total monies recovered by Contractor in the most recent 12-month period for Contractor’s total book of business as well as, if available, total monies recovered for Covered California business only. This description shall be provided upon the request of Covered California and will be updated upon request during each year that this Agreement is in effect and shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, Participating Providers, other subcontractors and their authorized Agents, including a summary of key findings, relevant data analytics and fraud risk assessments to circumvent fraud, waste, and abuse, and the development, implementation, and enforcement of any corrective action plans for changing, upgrading, or improving these programs. Contractor shall maintain and enforce a code of ethical conduct and make it available to Covered California upon request. Contractor shall refer potential fraud activities identified through fraud detection and response measures to Covered California. Contractor shall follow the established Carrier Referral Process posted on the Contractor’s extranet website provided by Covered California (Hub page, Contractor’s subsite, Data Integrity, Fraud Referral folder). Contractor shall not terminate Covered California Enrollee coverage for fraud without prior review and approval from Covered California.
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Xxxxx, Xxxxx and Abuse; Ethical Conduct. Contractor shall maintain and enforce policies, procedures, processes, systems, and internal controls (i) to reduce fraudFraud, wasteWaste, and abuseAbuse, and (ii) to enhance compliance with other applicable laws, rules, and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that includes a minimum of the following “7 Core Elements” as defined by CMS: Written Policies, Procedures and Standards of Conduct; Compliance Program Oversight; Training and Education Communication; Auditing and
Sample 1
Xxxxx, Xxxxx and Abuse; Ethical Conduct. Contractor shall maintain and enforce policies, procedures, processes, systems and internal controls (i) to reduce fraud, waste and abuse, and (ii) to enhance compliance with other applicable laws, rules and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that meets the requirements of applicable laws, rules and regulations. Contractor shall provide evidence of such compliance program as reasonably requested by the Exchange. Contractor shall timely communicate to the Exchange any material concerns identified by Contractor or by a regulatory agency related to regulatory compliance that may impact performance under this Agreement. Contractor shall provide the Exchange with a description of its fraud, waste and abuse detection and prevention programs and report total monies recovered by Contractor in the most recent 12- month period for issuer’s total book of business as well as total monies recovered for Covered California business only. This description shall be provided upon the request of the Exchange and will be updated during each year that this Agreement is in effect and shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, Participating Providers, other subcontractors and/or their authorized Agents, including a summary of key findings and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. Contractor shall maintain and enforce a code of ethical conduct and make it available to the Exchange upon request. Contractor shall refer potential fraud activities identified through fraud detection and response measures to the Exchange. Contractor shall follow the established Carrier Referral Process posted on the carrier extranet site provided by the Exchange. Contractor shall not terminate Enrollee coverage for fraud without prior review and approval from the Exchange.
Sample 1
Xxxxx, Xxxxx and Abuse; Ethical Conduct. Contractor shall maintain and enforce policies, procedures, processes, systems and internal controls (i) to reduce fraud, waste and abuse, and (ii) to enhance compliance with other applicable laws, rules and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that meets the requirements of applicable laws, rules and regulations. Contractor shall provide evidence of such compliance program as reasonably requested by the Exchange. Contractor shall timely communicate to the Exchange any material concerns identified by Contractor or by a regulatory agency related to regulatory compliance that may impact performance under this Agreement. Contractor shall provide the Exchange with a description of its fraud, waste and abuse detection and prevention programs and report total moneys recovered by Contractor in the most recent 12- month period in relation to Services provided to Enrollees. This description shall be provided upon the request of the Exchange and will be updated during each year that this Agreement is in effect and shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, Participating Providers, other subcontractors and/or their authorized Agents, including a summary of key findings and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. Contractor shall maintain and enforce a code of ethical conduct and make it available to the public through posting on Contractor’s website.
Sample 1

Related to Xxxxx, Xxxxx and Abuse; Ethical Conduct

  • Information Technology Accessibility Standards Any information technology related products or services purchased, used or maintained through this Grant must be compatible with the principles and goals contained in the Electronic and Information Technology Accessibility Standards adopted by the Architectural and Transportation Barriers Compliance Board under Section 508 of the federal Rehabilitation Act of 1973 (29 U.S.C. §794d), as amended. The federal Electronic and Information Technology Accessibility Standards can be found at: xxxx://xxx.xxxxxx-xxxxx.xxx/508.htm.

  • PREVENTION OF FRAUD AND XXXXXXX The Supplier represents and warrants that neither it, nor to the best of its knowledge any Supplier Personnel, have at any time prior to the Commencement Date: committed a Prohibited Act or been formally notified that it is subject to an investigation or prosecution which relates to an alleged Prohibited Act; and/or been listed by any government department or agency as being debarred, suspended, proposed for suspension or debarment, or otherwise ineligible for participation in government procurement programmes or contracts on the grounds of a Prohibited Act. The Supplier shall not during the Term: commit a Prohibited Act; and/or do or suffer anything to be done which would cause the Customer or any of the Customer’s employees, consultants, contractors, sub-contractors or agents to contravene any of the Relevant Requirements or otherwise incur any liability in relation to the Relevant Requirements. The Supplier shall during the Term: establish, maintain and enforce, and require that its Sub-Contractors establish, maintain and enforce, policies and procedures which are adequate to ensure compliance with the Relevant Requirements and prevent the occurrence of a Prohibited Act; keep appropriate records of its compliance with its obligations under Clause 14.3.1 and make such records available to the Customer on request; if so required by the Customer, within twenty (20) Working Days of the Commencement Date, and annually thereafter, certify to the Customer in writing that the Supplier and all persons associated with it or its Sub-Contractors or other persons who are supplying the Ordered Panel Services in connection with this Legal Services Contract are compliant with the Relevant Requirements. The Supplier shall provide such supporting evidence of compliance as the Customer may reasonably request; and have, maintain and where appropriate enforce an anti-bribery policy (which shall be disclosed to the Customer on request) to prevent it and any Supplier Personnel or any person acting on the Supplier's behalf from committing a Prohibited Act. The Supplier shall immediately notify the Customer in writing if it becomes aware of any breach of Clause 14.1, or has reason to believe that it has or any of the Supplier Personnel have: been subject to an investigation or prosecution which relates to an alleged Prohibited Act; been listed by any government department or agency as being debarred, suspended, proposed for suspension or debarment, or otherwise ineligible for participation in government procurement programmes or contracts on the grounds of a Prohibited Act; and/or received a request or demand for any undue financial or other advantage of any kind in connection with the performance of this Legal Services Contract or otherwise suspects that any person or Party directly or indirectly connected with this Legal Services Contract has committed or attempted to commit a Prohibited Act. If the Supplier makes a notification to the Customer pursuant to Clause 14.4, the Supplier shall respond promptly to the Customer's enquiries, co-operate with any investigation, and allow the Customer to audit any books, records and/or any other relevant documentation. If the Supplier breaches Clause 14.3, the Customer may by notice: require the Supplier to remove from performance of this Legal Services Contract any Supplier Personnel whose acts or omissions have caused the Supplier’s breach; or immediately terminate this Legal Services Contract. Any notice served by the Customer under Clause 14.4 shall specify the nature of the Prohibited Act, the identity of the Party who the Customer believes has committed the Prohibited Act and the action that the Customer has elected to take (including, where relevant, the date on which this Legal Services Contract shall terminate).

  • Professional Conduct Breaches of professional conduct and failure to perform at the established professional level are subject to disciplinary procedures. Examples of such breaches are: abuses of sick leave and other leaves, chronic tardiness, willful deficiencies in professional performance or proven incompetence, violation of Board policy, regulations and administrative directions not inconsistent with the terms of this Agreement and violation of the terms of this Agreement. Alleged breaches of professional conduct and reasons for possible disciplinary action shall be reported promptly to the offending Employee.

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