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.
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
Program Integrity Audit means: (i) Review of the actions of individuals or entities furnishing

Examples of Program Integrity Audit in a sentence

  • Contractor must report all suspected cases of FWA, including suspected Fraud committed by its employees, Providers, Subcontractors, Members, or any other third parties to OHA’s Program Integrity Audit Unit and DOJ’s Medicaid Fraud Control Unit (MFCU).

  • 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).

  • This Government Auditor 2 (GA 2) position is part of the Program Integrity Audit Unit in the Office for Program Integrity which reports directly to the Chief Financial Officer of the Fiscal Operations Division of OHA.

  • This position provides leadership and direct management supervision to the mid to upper-level professional auditors in the Program Integrity Audit Unit (PIAU) in the Fiscal and Operations Division of OHA.

  • WVCH, in conjunction with one delegated entity, resulted in the three FWA referrals so far in 2018.S. PERFORMANCE IMPROVEMENTActivity:• In an effort to better educate staff and delegated entities, WVCH requested a presentation by Paulette Golden, Program Integrity Audit Manager from OHA to the Transformation and Quality Committee (TraQ).

  • Report: Program Integrity Audit- Delegation RequirementsMeasurement: Policy and chart review to determine if services occur 24 hours a day, 7 days a week.Findings/Opportunities:Recommendations: 4.

  • Contractor shall report all suspected cases of Fraud, Waste, and Abuse, including suspected fraud committed by its employees and Subcontractors to the Medicaid Fraud Control Unit (“MFCU”) and the OHA Program Integrity Audit Unit (“PIAU”) in accordance with 42 CFR §455.23.

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;

  • Independent testing laboratory means an independent organization, accepted by the Contracting Officer, engaged to perform specific inspections or tests of the work, either at the site or elsewhere, and report the results of these inspections or tests.

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

  • 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.

  • Medical cannabis pharmacy means the same as that term is defined in Section 26-61a-102.

  • 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”.

  • 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 physician, employed with or contracted with the City, responsible for receiving laboratory results generated by the City's drug testing program who has knowledge of substance abuse disorders, laboratory testing procedures, and chain of custody collection procedures; who verifies positive, confirmed test results, and who has the necessary and appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with his or her medical history and any other relevant biomedical information.

  • 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 “PMP,” or “program” means the program established pursuant to 657—Chapter 37 for the collection and maintenance of PMP information and for the provision of PMP information to authorized individuals.

  • Investigator means an individual who is:

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Medical Review Officer (MRO) means a licensed physician responsible for receiving and reviewing laboratory results generated by the school district’s drug testing program and for evaluating medical explanations for certain drug tests.