Program Integrity Audit definition

Program Integrity Audit and “PI Audit” each means, but is not limited to, the review of Medicaid claims for suspicious aberrancies to establish evidence that fraud, waste, or abuse has occurred, is likely to occur, or whether actions of individuals or entities have the potential for resulting in an expenditure of Medicaid funds which is not intended under the provisions of this Contract, State or Federal Medicaid regulations, and whether improper payment has occurred.
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Program Integrity Audit and “PI Audit” each means, but is not limited to, the review of Medicaid claims for suspicious aberrancies to establish evidence that
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Program Integrity Audit means: (i) Review of the actions of individuals or entities furnishing
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Examples of Program Integrity Audit in a sentence

  • Provide upon request by either OHA, the Program Integrity Audit Unit (PIAU), the Office of Payment Accuracy and Recovery (OPAR), the Oregon Secretary of State's Office, Federal Government, and the Department of Justice (DOJ) Medicaid Fraud Control Unit (MFCU), or any duly authorized representatives, immediate access to review and make copies of any and all records relied on by Provider in support of care, services, equipment or supplies billed to the Oregon medical assistance program.

  • The BHRS provider will receive audit notification from the VBH-PA Program Integrity Audit Lead.

  • By advertising on the targeted networks, CIFOR hoped to get more applicants that had educational backgrounds and working experience in areas that are in-line with CUF and had future goals related to Indonesia’s ways of managing its resources.

  • Such reporting may be made by mail, phone, or facsimile transmission using the following contact information: Medicaid Fraud Control Unit (MFCU) Oregon Department of Justice 100 SW Market Street Portland, OR 97201 Phone: 971-673-1880 Fax: 971-673-1890 OHA Program Integrity Audit Unit (PIAU) 3406 Cherry Ave.

  • As a Government Auditor, you will support the Fiscal and Operations Division, the Office for Program Integrity (OPI), and the Program Integrity Audit Unit within the Oregon Health Authority (OHA).

  • For example, DDRI prepares quarterly Program Integrity Audit and Fraud & Abuse reports.

  • ReportingProviders will promptly (within five (5) business days) refer all verified and/or suspected cases of fraud and abuse, including fraud by their employees and subcontractors, to the Medicaid Fraud Control Unit (MFCU) and to the OHA Program Integrity Audit Unit and to the relevant Behavioral Health Plan Partners of Health Share.

  • Program Integrity Audit AppealsAll appeals related to audits originating from Program Integrity resulting in overpayments are heard by an Administrative Law Judge (ALJ) pursuant to 56 O.S. § 1011.956 Oklahoma Statutes (O.S.) § 1011.9.

  • The DMA Program Integrity PCS Audit Guide directly contradicts the Audit Unit’s understanding of the policy stating that the PACT form must be authorized by a “primary physician’s practice.” The Program Integrity Audit guide also states that if the appropriate practice signs page 4 of the PACT authorizing the need for service, there should be no recoupment.

  • The BHRS provider may request a conference call with the VBH-PA Program Integrity Audit Team.

Related to Program Integrity Audit

  • DHHS means the Department of Health and Human Services.

  • Independent educational evaluation means an evaluation conducted by a qualified examiner who is not employed by the public agency responsible for the education of the child in question.

  • Research record means any data, document, computer file, computer diskette, or any other written or non-written account or object that reasonably may be expected to provide evidence or information regarding the proposed, conducted, or reported research that constitutes the subject of an allegation of research misconduct. A research record includes, but is not limited to, grant or contract applications, whether funded or unfunded; grant or contract progress and other reports; laboratory notebooks; notes; correspondence; videos; photographs; X-ray film; slides; biological materials; computer files and printouts; manuscripts and publications; equipment use logs; laboratory procurement records; animal facility records; human and animal subject protocols; consent forms; medical charts; and patient research files.

  • Clinical evaluation means a systematic and planned process to continuously generate, collect, analyse and assess the clinical data pertaining to a device in order to verify the safety and performance, including clinical benefits, of the device when used as intended by the manufacturer;

  • Research Analyst means any individual employed by Loomis Sayles who has been designated as a Research Analyst or Research Associate by Loomis Sayles. A person is considered a Research Analyst only as to those Covered Securities which he or she is assigned to cover and about which he or she issues research reports to other Investment Persons or otherwise makes recommendations to Investment Persons beyond publishing their research. As to other securities, he or she is simply an Access Person.

  • District Evaluation Advisory Committee means a group created to oversee and guide the planning and implementation of the Board of Education's evaluation policies and procedures as set forth in N.J.A.C. 6A:10-2.3.

  • Integrity Commissioner means the Integrity Commissioner appointed by Council pursuant to Section 223.3 of the Municipal Act, 2001;

  • Controller of Examinations means the Controller of Examinations of the University;

  • Summary Subcontract Report (SSR) Coordinator, as used in this clause, means the individual at the department or agency level who is registered in eSRS and is responsible for acknowledging or rejecting SSRs in eSRS for the department or agency.

  • Architectural Review Committee or “ARC” shall mean the architectural review committee established by the Organization to review plans submitted to the Organization for architectural review.

  • Project Management Report means each report prepared in accordance with Section 4.02 of this Agreement;

  • Medical examination means the preliminary assessment of a person by an authorized health worker or by a person under the direct supervision of the competent authority, to determine the person’s health status and potential public health risk to others, and may include the scrutiny of health documents, and a physical examination when justified by the circumstances of the individual case;

  • Regulatory Floodway means the channel of a river or other watercourse and the adjacent land areas that must be reserved in order to discharge the base flood without cumulatively increasing the water surface elevation more than a designated height.

  • Department compliance officer means an individual who is:

  • Collaborative drug therapy management means participation by an authorized pharmacist and a physician in the management of drug therapy pursuant to a written community practice protocol or a written hospital practice protocol.

  • Investigating Department means any department / division / office of SCI investigating into the conduct of the Entity and shall include the Vigilance Department, “Central Bureau of Investigation, the State Police or any other authority or entity set up by the Central or State Government having powers to investigate”.

  • medical surveillance means a planned programme or periodic examination (which may include clinical examinations, biological monitoring or medical tests) of employees by an occupational health practitioner or, in prescribed cases, by an occupational medicine practitioner;

  • Medical evaluation means the process of assessing an individual's health status that includes a medical history and a physical examination of an individual conducted by a licensed medical practitioner operating within the scope of his license.

  • HHS means the United States Department of Health and Human Services.

  • Practical examination means a demonstration through application of the safety rules and principles in industrial radiography including use of all procedures and equipment to be used by radiographic personnel.

  • Medical Review Officer (MRO means a licensed M.D. or D.O. with knowledge of drug abuse disorders, employed or used by the City to review drug results in accordance with this procedure.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Police Department means the Police Department of the City and County of San Francisco.

  • Clinical review criteria means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by a health carrier to determine the necessity and appropriateness of health care services.

  • Prescription monitoring program means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

  • Investigator means an individual who is: