Examples of Allegation of Fraud in a sentence
Credible Allegation of Fraud – May be an allegation which has been verified by the state, from any source, including but not limited to the following: Fraud hotline complaints, claims data mining, and patterns identified through provider audits, civil false claims cases, and law enforcement investigations.
Credible Allegation of Fraud - May be an allegation which has been verified by the state, from any source, including but not limited to the following: Fraud hotline complaints, claims data mining, and patterns identified through provider audits, civil false claims cases, and law enforcement investigations.
If the CSHCD SCRBH fails to suspend payments to an entity or Individual for whom there is a pending investigation of a Credible Allegation of Fraud without good cause, and HCA directed the CSHCD SCRBH to suspend payments, HCA may impose sanctions in accordance with the Sanctions Subsection of CSHCD SCRBH’s HCA Contract.
HCA determines, based upon the submission of written evidence by the CSHCD SCRBH, Individual, or entity that is the subject of the payment suspension, there is no longer a Credible Allegation of Fraud and that the suspension should be removed.
The Provider Notice form must be accompanied by the MCO’s complete investigative file, including but not limited to as applicable, preliminary investigation results, interviews, all records or documents collected, line by line review findings that substantiate any under or Overpayment, evidence supporting a Credible Allegation of Fraud, reviewer/investigative notes, Provider enrollment and Credentialing documents, related complaints, related data analysis, and any applicable repayment history.