Xxxxx, Xxxxx and Abuse; Ethical Conduct Sample Clauses

Xxxxx, Xxxxx 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 other applicable laws, rules, and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that meets the requirements of applicable laws, rules, and regulations. Contractor shall provide evidence of such compliance program as reasonably requested by Covered California. Contractor shall timely communicate to Covered California any material concerns identified by Contractor or by State and Federal Regulators related to regulatory compliance that may impact performance under this Agreement. Contractor shall provide Covered California with a description of its fraud, waste and abuse detection and prevention programs and report total monies recovered by Contractor from providers in the most recent 12-month period for Contractor’s total book of business as well as, if available, total monies recovered for Covered California business only. This description shall be provided upon the request of Covered California and will be updated upon request during each year that this Agreement is in effect and shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, Participating Providers, other subcontractors and their authorized agents, including a summary of key findings, relevant data analytics and fraud risk assessments to circumvent fraud, waste, and abuse, and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. Contractor shall maintain and enforce a code of ethical conduct and make it available to Covered California upon request. Contractor shall refer potential fraud activities identified through fraud detection and response measures to Covered California. Contractor shall follow the established Carrier Referral Process posted on the Contractor’s extranet website provided by Covered California (Hub page, Contractor’s subsite, Data Integrity, Fraud Referral folder). Contractor shall not terminate Covered California Enrollee coverage for fraud without prior review and approval from Covered California.
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Xxxxx, Xxxxx and Abuse; Ethical Conduct. Contractor shall maintain and enforce policies, procedures, processes, systems, and internal controls (i) to reduce fraudFraud, wasteWaste, and abuseAbuse, and (ii) to enhance compliance with other applicable laws, rules, and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that includes a minimum of the following “7 Core Elements” as defined by CMS: Written Policies, Procedures and Standards of Conduct; Compliance Program Oversight; Training and Education Communication; Auditing and
Sample 1
Xxxxx, Xxxxx 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 other applicable laws, rules and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that meets the requirements of applicable laws, rules and regulations. Contractor shall provide evidence of such compliance program as reasonably requested by the Exchange. Contractor shall timely communicate to the Exchange any material concerns identified by Contractor or by a regulatory agency related to regulatory compliance that may impact performance under this Agreement. Contractor shall provide the Exchange with a description of its fraud, waste and abuse detection and prevention programs and report total monies recovered by Contractor in the most recent 12- month period for issuer’s total book of business as well as total monies recovered for Covered California business only. This description shall be provided upon the request of the Exchange and will be updated during each year that this Agreement is in effect and shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, Participating Providers, other subcontractors and/or their authorized Agents, including a summary of key findings and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. Contractor shall maintain and enforce a code of ethical conduct and make it available to the Exchange upon request. Contractor shall refer potential fraud activities identified through fraud detection and response measures to the Exchange. Contractor shall follow the established Carrier Referral Process posted on the carrier extranet site provided by the Exchange. Contractor shall not terminate Enrollee coverage for fraud without prior review and approval from the Exchange.
Sample 1
Xxxxx, Xxxxx 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 other applicable laws, rules and regulations in connection with the performance of Contractor’s obligations under this Agreement. Contractor shall maintain an effective compliance program that meets the requirements of applicable laws, rules and regulations. Contractor shall provide evidence of such compliance program as reasonably requested by the Exchange. Contractor shall timely communicate to the Exchange any material concerns identified by Contractor or by a regulatory agency related to regulatory compliance that may impact performance under this Agreement. Contractor shall provide the Exchange with a description of its fraud, waste and abuse detection and prevention programs and report total moneys recovered by Contractor in the most recent 12- month period in relation to Services provided to Enrollees. This description shall be provided upon the request of the Exchange and will be updated during each year that this Agreement is in effect and shall include an overview of fraud and abuse detection and prevention program activities conducted by Contractor, Participating Providers, other subcontractors and/or their authorized Agents, including a summary of key findings and the development, implementation and enforcement of any corrective action plans for changing, upgrading, or improving these programs. Contractor shall maintain and enforce a code of ethical conduct and make it available to the public through posting on Contractor’s website.
Sample 1

Related to Xxxxx, Xxxxx and Abuse; Ethical Conduct

  • Ethical Conduct Seller's employees shall comply with the BorgWarner Supplier Code of Conduct articulated within the BorgWarner Supplier Manual. Compliance with these standards is a mandatory component of Buyer's purchase contracts worldwide and must also apply to Seller subcontractors. Both, the BorgWarner Supplier Code of Conduct and the BorgWarner Supplier Manual are incorporated by reference as part of the Purchase Order, are binding on the Seller, and Seller explicitly verifies to have read and accepted the BorgWarner Supplier Code of Conduct and the BorgWarner Supplier Manual.

  • General Conduct The BSC has specific policies governing conduct in the units, including, but not limited to, assault, harassment, sexual harassment, host, alcohol, party and substance abuse policies. Member agrees to read and abide by these policies. Failure to follow BSC conduct policies will lead to a range of sanctions up to and including termination of this contract and BSC membership.

  • Fraud, Waste, and Abuse Contractor understands that HHS does not tolerate any type of fraud, waste, or abuse. Violations of law, agency policies, or standards of ethical conduct will be investigated, and appropriate actions will be taken. Pursuant to Texas Government Code, Section 321.022, if the administrative head of a department or entity that is subject to audit by the state auditor has reasonable cause to believe that money received from the state by the department or entity or by a client or contractor of the department or entity may have been lost, misappropriated, or misused, or that other fraudulent or unlawful conduct has occurred in relation to the operation of the department or entity, the administrative head shall report the reason and basis for the belief to the Texas State Auditor’s Office (SAO). All employees or contractors who have reasonable cause to believe that fraud, waste, or abuse has occurred (including misconduct by any HHS employee, Grantee officer, agent, employee, or subcontractor that would constitute fraud, waste, or abuse) are required to immediately report the questioned activity to the Health and Human Services Commission's Office of Inspector General. Contractor agrees to comply with all applicable laws, rules, regulations, and System Agency policies regarding fraud, waste, and abuse including, but not limited to, HHS Circular C-027. A report to the SAO must be made through one of the following avenues: ● SAO Toll Free Hotline: 1-800-TX-AUDIT ● SAO website: xxxx://xxx.xxxxx.xxxxx.xx.xx/ All reports made to the OIG must be made through one of the following avenues: ● OIG Toll Free Hotline 0-000-000-0000 ● OIG Website: XxxxxxXxxxxXxxxx.xxx ● Internal Affairs Email: XxxxxxxxXxxxxxxXxxxxxxx@xxxx.xxxxx.xx.xx ● OIG Hotline Email: XXXXxxxxXxxxxxx@xxxx.xxxxx.xx.xx. ● OIG Mailing Address: Office of Inspector General Attn: Fraud Hotline MC 1300 P.O. Box 85200 Austin, Texas 78708-5200

  • Compliance with Xxxxx-Xxxxx and Related Act requirements All rulings and interpretations of the Xxxxx-Xxxxx and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract.

  • Professional Conduct Breaches of professional conduct and failure to perform at the established professional level are subject to disciplinary procedures. Examples of such breaches are: abuses of sick leave and other leaves, chronic tardiness, willful deficiencies in professional performance or proven incompetence, violation of Board policy, regulations and administrative directions not inconsistent with the terms of this Agreement and violation of the terms of this Agreement. Alleged breaches of professional conduct and reasons for possible disciplinary action shall be reported promptly to the offending Employee.

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