Examples of Credible allegation of fraud in a sentence
Credible Allegation of Fraud: Any allegation of Fraud that has been verified by another State, the Government, or ASES, or otherwise has been preliminary investigated by the Contractor, as the case may be, and that has indicia of reliability that comes from any source.
Upon notification by the Department that a Provider has been placed on a payment suspension due to a Credible Allegation of Fraud pursuant to 42 CFR § 455.23, CONTRACTOR must suspend payments to any Providers and/or administrative entities involved.
Suspension of Payment Based on Credible Allegation of Fraud The CONTRACTOR must have a provision for suspension of payments to a Provider for which the Department determines there is a Credible Allegation of Fraud in accordance with 42 CFR § 455.23.
Individuals or Entities Pending Fraud Investigation Non-Emergency items or service furnished by an individual or entity to whom the State, or the CONTRACTOR at the direction of the State, has failed to suspend payments during any period when there is a pending investigation of a Credible Allegation of Fraud against the individual or entity, unless the State determines there is good cause to not suspend such payments.
Suspension of Payment for Credible Allegation – In accordance with § 42 CFR 455.23 Suspension of payment in cases of fraud, means that all Medicaid payments to a Provider are suspended after the agency determines there is a Credible Allegation of Fraud for which an investigation is pending under the Medicaid Program against an individual or entity unless the agency has good cause to not suspend payments or to suspend payment only in part.