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.
Sample 1Sample 2Sample 3
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
Sample 1Sample 2
Program Integrity Audit means: (i) Review of the actions of individuals or entities furnishing
Sample 1Sample 2

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.


More Definitions of Program Integrity Audit

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
Sample 1

Related to Program Integrity Audit

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

  • 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 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.

  • 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.

  • Investigator means an individual who is: