Common use of REPORT, IRO REPORTS AND ANNUAL REPORTS Clause in Contracts

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village and the third- party billing company required by Section III.H (if applicable);‌ 5. a list of all of the Practice’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇▇▇▇▇ shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between . ▇▇▇▇ or Village and the IRO;‌▇▇▇▇;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇▇▇▇▇ has screened all Covered Persons against the Exclusion List, as required by Section section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇▇▇▇▇▇▇ and Village and the third- third party billing company required by Section III.H (if applicable);‌III.H;‌ 5. a list of all of the PracticeDr. Muttath’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice ▇▇. ▇▇▇▇▇▇▇ is in compliance with all of the requirements of this IA; and (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌truthful.‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇▇▇▇ shall submit a written report to OIG summarizing the status of its his implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇. ▇▇▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇. ▇▇▇▇▇▇ or Village and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇▇▇▇ has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇▇▇▇▇▇ and Village and the third- third-party billing company required by Section III.H (if applicable);‌III.H;‌ 5. a list of all of the Practice’s ▇▇. ▇▇▇▇▇▇’▇ locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice ▇▇. ▇▇▇▇▇▇ is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice I&L shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌I&L;‌ 3. a copy of the search result print screens demonstrating that the Practice I&L has screened all Covered Persons against the Exclusion List, as required by Section section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village I&L and the third- third party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticeI&L’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification certifications by I&L Pharmacy, ▇▇▇▇▇▇▇▇▇, and Babchinetskaya that: (a) he or she has they have reviewed the IA in its entirety, understands understand the requirements described within, and maintains maintain a copy for reference; (b) to the best of his or her their knowledge, except as otherwise described in the Implementation Report, the Practice I&L is in compliance with all of the requirements of this IA; (c) he or she has they have reviewed the Implementation Report and has have made a reasonable inquiry regarding its content and believes believe that the information is accurate and truthful; and (d) he or she understands they understand that the certification is being provided to and relied upon by the United States‌States.‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇▇▇ shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇. ▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌Cancer Centers;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇▇▇ has screened all Covered Persons against the Exclusion List, as required by Section III.DIII.E, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇▇▇▇▇ and Village and the third- third party billing company required by Section III.H III.I (if applicable);‌ 5. a list of all of ▇▇. ▇▇▇▇▇’▇ and the Practice’s Cancer Centers’ locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, ▇▇. ▇▇▇▇▇ and the Practice is Cancer Centers are in compliance with all of of‌ the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌States

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇▇▇▇▇▇▇ Clinic shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇▇▇▇and Village Clinic that includes a summary of all current and prior engagements between ▇▇▇▇▇▇▇or Village Clinic and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇▇▇▇▇▇▇ Clinic has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇▇▇▇and Village Clinic and the third- third-party billing company required by Section III.H (if applicable);‌ 5. a list of all of the Practice▇▇▇▇▇▇▇▇ Clinic’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇ ▇. Escandon, Jr. that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice ▇▇▇▇▇▇▇▇ Clinic is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇▇▇▇▇ shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇▇▇▇▇ has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇▇▇ and Village and the third- third party billing company required by Section III.H (if applicable);‌ 5. a list of all of the Practice’s ▇▇▇▇▇▇’▇ locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and and‌ each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌and‌‌ 6. a certification by ▇▇▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice ▇▇▇▇▇▇ is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌IA;‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice Hanflink shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌Hanflink;‌ 3. a copy of the search result print screens demonstrating that the Practice Hanflink has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village Hanflink and the third- third party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticeHanflink’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇ Hanflink that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice Hanflink is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌IA;‌‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇▇▇▇▇▇▇▇-AFAS shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between . ▇▇▇▇ or Village and the IRO;‌▇▇▇▇▇▇▇-AFAS;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇▇▇▇▇▇▇▇-AFAS has screened all Covered Persons against the Exclusion List, as required by Section section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇ and Village ▇▇▇▇▇▇▇▇▇-AFAS and the third- third party billing company required by Section III.H (if applicable);‌III.H;‌ 5. a list of all of the Practice▇▇. ▇▇▇▇▇▇▇▇▇▇-AFAS’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇▇▇▇▇▇-AFAS that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice ▇▇. ▇▇▇▇▇▇▇▇▇▇-AFAS is in compliance with all of the requirements of this IA; and (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌truthful.‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice LCPCC shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌LCPCC;‌ 3. a copy of the search result print screens demonstrating that the Practice LCPCC has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village and the third- party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticeLCPCC’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 65. a certification certifications by ▇▇▇▇▇▇▇▇▇▇▇. ▇▇▇▇▇▇▇. ▇▇▇▇▇ ▇.▇▇▇▇▇▇▇, and LCPCC that: (a) he or he/she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice LCPCC is in compliance with all of the requirements of this IA; (c) he or he/she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or he/she understands that the certification is being provided to and relied upon by the United States‌States.‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C. shall submit a written report to OIG summarizing the status of its their implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇. ▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇▇▇▇ or Village and the IRO;‌Fleckner, P.C.;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C. has screened all Covered Persons against the Exclusion List, as required by Section III.DIII.E, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇▇▇▇▇▇▇▇ and Village Fleckner, P.C. and the third- third party billing company required by Section III.H III.I (if applicable);‌applicable);‌‌ 5. a list of all of the Practice▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C.’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C. that: (a) he or she has they have reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her their knowledge, except as otherwise described in the Implementation Report, the Practice ▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C. is in compliance with all of the requirements of this IA; (c) he or she has they have reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands they understand that the certification is being provided to and relied upon by the United States‌ B. Quarterly Reports‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice Practitioner shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village Practitioner that includes a summary of all current and prior engagements between ▇▇▇▇ or Village Practitioner and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice Practitioner has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village Practitioner and the third- third-party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticePractitioner’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇ and Interventional Cardiology shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with with‌ respect to ▇▇. ▇▇▇ and Village Interventional Cardiology that includes a summary of all current and prior engagements between ▇▇. ▇▇▇ or Village and Interventional Cardiology and the IRO;‌IRO; 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇ and Interventional Cardiology has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇▇▇ and Village Interventional Cardiology and the third- third-party billing company required by Section III.H (if applicable);‌ 5. a list of all of the Practice▇▇. ▇▇▇ and Interventional Cardiology’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice Bhayani shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village Bhayani that includes a summary of all current and prior engagements between ▇▇▇▇ or Village Bhayani and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice Bhayani has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village Bhayani and the third- third-party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticeBhayani’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇ Bhayani that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice Bhayani is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌IA;‌‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice Springfield shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌Springfield;‌ 3. a copy of the search result print screens demonstrating that the Practice Springfield has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇▇▇ and Village Springfield and the third- third party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticeSpringfield’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇▇▇▇▇▇▇▇’s president that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice Springfield is in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice ▇▇. ▇▇▇▇▇▇ shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇. ▇ and Village that includes a summary of all current and prior engagements between ▇▇▇▇ or Village and the IRO;‌MRA;‌ 3. a copy of the search result print screens demonstrating that the Practice ▇▇. ▇▇▇▇▇▇ has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from ▇▇. ▇▇▇▇▇▇ and Village and the third- third party billing company required by Section III.H (if applicable);‌ 5. a list of all of the Practice▇▇. ▇▇▇▇▇▇ and MRA’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇. ▇▇▇▇▇▇ that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice is ▇▇. ▇▇▇▇▇▇ and MRA are in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and and‌ truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌States

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice Dakwa and HEAG shall submit a written report to OIG summarizing the status of its their implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to ▇▇▇▇ Dakwa and Village HEAG that includes a summary of all current and prior engagements between ▇▇▇▇ or Village Dakwa and the IRO and HEAG and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice has Dakwa and HEAG have screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌Date;‌‌ 4. a copy of any certifications from ▇▇▇▇ and Village Dakwa, HEAG and the third- third-party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticeDakwa and HEAG’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by ▇▇▇▇▇, in his individual capacity and on behalf of HEAG, that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice is Dakwa and HEAG are in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌

Appears in 1 contract

Sources: Integrity Agreement

REPORT, IRO REPORTS AND ANNUAL REPORTS. ‌ A. Implementation Report‌ Within 90 days after the Effective Date, the Practice PC, ▇▇▇▇▇, and Bandar shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include: 1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;‌ 2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to PC, ▇▇▇▇▇, and Village Bandar that includes a summary of all current and prior engagements between PC, ▇▇▇▇ or Village ▇▇, and Bandar and the IRO;‌ 3. a copy of the search result print screens demonstrating that the Practice has PC, ▇▇▇▇▇, and Bandar have screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;‌ 4. a copy of any certifications from PC, ▇▇▇▇▇, and Village Bandar and the third- third-party billing company required by Section III.H (if applicable);‌ 5. a list of all of the PracticePC, ▇▇▇▇▇, and Bandar’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and‌ 6. a certification by PC, ▇▇▇▇▇, and Bandar that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, the Practice is PC, ▇▇▇▇▇, and Bandar are in compliance with all of the requirements of this IA; (c) he or she has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and and‌ believes that the information is accurate and truthful; and (d) he or she understands that the certification is being provided to and relied upon by the United States‌States

Appears in 1 contract

Sources: Integrity Agreement