Program Integrity Screening definition

Program Integrity Screening means a review of an individual’s or entity’s program integrity history and current status, which may include a review of the individual’s or entity’s eligibility, history of exclusion or other sanctions imposed with respect to participation in Medicare, Medicaid, or CHIP; history of failure to pay Medicare debts in a timely manner; current or prior law enforcement investigations or administrative actions; affiliations with individuals or entities that have a history of program integrity issues; and other information pertaining to the trustworthiness of the individual or entity.

Program Integrity Screening means a review of an individual’s or entity’s program integrity history, which may include a review of the individual’s or entity’s history of exclusion or other sanctions imposed with respect to participation in Medicare, Medicaid, or CHIP; history of failure to pay Medicare debts in a timely manner; current or prior law enforcement investigations or administrative actions; affiliations with individuals or entities that have a history of program integrity issues; and other information pertaining to the trustworthiness of the individual or entity.

Program Integrity Screening means a review of an individual’s or entity’s program integrity history, which may include a review of Medicare or Medicaid, or any combination of the two, program exclusions or other sanctions, current or prior law enforcement investigations or administrative actions, affiliations with individuals or entities that have a history of program integrity issues, or other information pertaining to the trustworthiness of the individual or entity.

Examples of Program Integrity Screening in a sentence

• CMS shall conduct a Program Integrity Screening for each individual and entity on the Proposed Revised Participant Provider List and the Proposed Revised Preferred Provider List.

• With respect to each New Entity identified on the Proposed Updated Financial Arrangement List, CMS will conduct a Program Integrity Screening.

• Any such requests shall be made in accordance with the procedures set forth in section 5.2, except that CMS need not conduct a Program Integrity Screening in the case of a request to make a late addition to the certified Care Partner List or a request to increase the number of CRP Tracks in which a Care Partner or Downstream Care Partner is participating.

• Make available to staff in Salem, Eugene, Roseburg and White City.♦ Health Promotion – Link into health promotion, clinical reminder for end of life care.♦ Technology – Integrate PC into technology as appropriate; CPRS, add to and update, Power Point Program, Web site.♦ Resource Consultants – Expert resource available for consultation 24 hours per day.

• CMS will conduct a Program Integrity Screening of this proposed Initial Financial Arrangement List.

• CMS may also conduct a Program Integrity Screening on the Participant and any Downstream Episode Initiator previously identified on the Participant Profile.

• CMS may reject any Downstream Episode Initiator listed on the initial Participant Profile on the basis of the results of a Program Integrity Screening, history of program integrity issues, or if CMS determines that the entity does not satisfy the definition of an Episode Initiator.

• With respect to each Downstream Episode Initiator identified on the initial Participant Profile, CMS will conduct a Program Integrity Screening.

• With respect to each new Downstream Episode Initiator identified on an updated Participant Profile submitted in accordance with Article 5.5(c)(1), CMS will conduct a Program Integrity Screening.

• CMS may also conduct a Program Integrity Screening on the Participant and any NPRA Sharing Partner, NPRA Sharing Group Practice Practitioner, and BPCI Advanced Entity previously identified on the Financial Arrangement List.