Common use of Compliance Programs Clause in Contracts

Compliance Programs. (a) Fraud, Waste 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 applicable Laws in connection with the performance of Contractor’s obligations under this Contract. (b) The parties acknowledge that the State shall be responsible for Enrollee fraud prevention and detection relating to Enrollee eligibility. Contractor will cooperate to support the State in its efforts in this area. (c) Contractor shall maintain an effective compliance program that meets the requirements of applicable Laws. Contractor shall provide evidence of such compliance program as reasonably requested by the State. Contractor shall timely communicate to the State any material concerns identified by Contractor related to material regulatory compliance issues. (d) On an annual basis, starting in 2015, Contractor shall provide the State with a description of its fraud, waste and abuse detection and prevention efforts for previous calendar year, and report total moneys recovered or savings realized by Contractor for Enrollees in the most recent 12-month period in relation to claims paid pursuant to this Contract, no later than February 15 of each year. This description shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, including a summary of key findings and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. (e) Contractor shall maintain and enforce a code of ethical conduct that shall be made available to the public through posting on Contractor’s website.

Compliance Programs. (a) Fraud, Waste ▇▇▇▇▇ 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 applicable Laws in connection with the performance of Contractor’s obligations under this Contract. (b) The parties acknowledge that the State shall be responsible for Enrollee fraud prevention and detection relating to Enrollee eligibility. Contractor will cooperate to support the State in its efforts in this area. (c) Contractor shall maintain an effective compliance program that meets the requirements of applicable Laws. Contractor shall provide evidence of such compliance program as reasonably requested by the State. Contractor shall timely communicate to the State any material concerns identified by Contractor related to material regulatory compliance issues. (d) On an annual basis, starting in 2015, Contractor shall provide the State with a description of its fraud, waste and abuse detection and prevention efforts for previous calendar year, and report total moneys recovered or savings realized by Contractor for Enrollees in the most recent 12-month period in relation to claims paid pursuant to this Contract, no later than February 15 of each year. This description shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, including a summary of key findings and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. (e) Contractor shall maintain and enforce a code of ethical conduct that shall be made available to the public through posting on Contractor’s website.