Common use of Distinct Unit Clause in Contracts

Distinct Unit. The contractor shall establish a distinct fraud and abuse unit, separate from the contractor's utilization review and quality of care functions. The unit can either be part of the contractor's corporate structure, or operate under contract with the contractor. The unit shall be staffed with individuals with the qualifications and an investigator-to-beneficiary ratio consistent, at a minimum, with the Department of Banking and Insurance requirements for fraud units within health insurance carriers or greater ratio as needed to meet the demands.

Distinct Unit. The contractor shall establish a distinct fraud and abuse unit, separate from the contractor's utilization review and quality of care functions. The unit can either be part of the contractor's corporate structure, or operate under contract with the contractor. The unit shall be staffed with individuals with the qualifications and an investigator-to-beneficiary ratio consistent, at a minimum, with the Department of Banking and Insurance requirements for fraud units within health insurance carriers or greater ratio as needed to meet the demands.the