OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph E or has failed to carry out its responsibilities as described in Paragraph C, OIG shall notify Indivior in writing regarding OIG’s basis for determining that the IRO has not met the requirements of this Appendix. Indivior shall have 30 days from the date of OIG’s written notice to provide information regarding the IRO’s qualifications, independence or performance of its responsibilities in order to resolve the concerns identified by OIG. If, following OIG’s review of any information provided by Indivior regarding the IRO, OIG determines that the IRO has not met the requirements of this Appendix, OIG shall notify Indivior in writing that Indivior shall be required to engage a new IRO in accordance with Paragraph A of this Appendix. Indivior must engage a new IRO within 60 days of its receipt of OIG’s written notice. The final determination as to whether or not to require Indivior to engage a new IRO shall be made at the sole discretion of OIG. APPENDIX B INDEPENDENT REVIEW ORGANIZATION REVIEWS
OIG Removal of IRO. In the event OIG has reason to believe that the IRO does not possess the qualifications described in Paragraph B, is not independent and/or objective as set forth in Paragraph D, or has failed to carry out its responsibilities as described in Paragraph C, OIG may, at its sole discretion, require GSK to engage a new IRO in accordance with Paragraph A of this Appendix. GSK must engage a new IRO within 60 days of termination of the IRO. Prior to requiring GSK to engage a new IRO, OIG shall notify GSK of its intent to do so and provide a written explanation of why OIG believes such a step is necessary. To resolve any concerns raised by OIG, GSK may present additional information regarding the IRO’s qualifications, independence or performance of its responsibilities. OIG will attempt in good faith to resolve any differences regarding the IRO with GSK prior to requiring GSK to terminate the IRO. However, the final determination as to whether or not to require GSK to engage a new IRO shall be made at the sole discretion of OIG. Appendix B to CIA for GlaxoSmithKline LLC Independent Review Organization Reviews I. Covered Functions Review, General Description As specified more fully below, GlaxoSmithKline (GSK) shall retain an Independent Review Organization (IRO) (or IROs) to perform reviews (IRO Reviews) to assist GSK in assessing and evaluating its systems, processes, policies, procedures, and practices related to certain of GSK's Covered Functions (collectively, “IRO Covered Functions”). The IRO Review shall consist of two components - a systems review (Systems Review) and a transactions review (Transactions Review) as described more fully below. GSK may engage, at its discretion, a single IRO to perform both components of the IRO Review provided that the entity has the necessary expertise and capabilities to perform both. If there are no material changes in GSK’s systems, processes, policies, and procedures relating to the Covered IRO Functions, the IRO shall perform the Systems Review for the second and fifth IRO Reporting Periods. If GSK materially changes its systems, processes, policies, and procedures relating to the Covered IRO Functions, the IRO shall perform a Systems Review for the IRO Reporting Period(s) in which such changes were made in addition to conducting the Review for the second and fifth IRO Reporting Periods. The additional Systems Review(s) shall consist of: 1) an identification of the material changes; 2) an assessment of whether other sys...
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph E, or has failed to carry out its responsibilities as described in Paragraph C, OIG shall notify Genova in writing regarding OIG’s basis for determining that the IRO has not met the requirements of this Appendix. Genova shall have 30 days from the date of OIG’s written notice to provide information regarding the IRO’s qualifications, independence or performance of its responsibilities in order to resolve the concerns identified by OIG. If, following OIG’s review of any information provided by Genova regarding the IRO, OIG determines that the IRO has not met the requirements of this Appendix, OIG shall notify Genova in writing that Genova shall be required to engage a new IRO in accordance with Paragraph A of this Appendix. Genova must engage a new IRO within 60 days of its receipt of OIG’s written notice. The final determination as to whether or not to require Genova to engage a new IRO shall be made at the sole discretion of OIG.
OIG Removal of IRO. In the event OIG has reason to believe that the IRO does not possess the qualifications described in Section II, is not independent and objective as set forth in Section IV (or that the Legal IRO has a relationship to KDMC prohibited under Section IV), or has failed to carry out its responsibilities as described in Section III, OIG may, at its sole discretion, require KDMC to engage a new IRO in accordance with Section I of this Appendix. KDMC must engage a new IRO within 60 days of termination of the IRO. Prior to requiring KDMC to engage a new IRO, OIG shall notify KDMC of its intent to do so and provide a written explanation of why OIG believes such a step is necessary. To resolve any concerns raised by OIG, KDMC may present additional information regarding the IRO’s qualifications, independence or performance of its responsibilities. OIG will attempt in good faith to resolve any differences regarding the IRO with KDMC prior to requiring KDMC to terminate the IRO. However, the final determination as to whether or not to require KDMC to engage a new IRO shall be made at the sole discretion of OIG. APPENDIX B INTERVENTIONAL CARDIAC PROCEDURES REVIEW
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph D, or has failed to carry out its responsibilities as described in Paragraph C, OIG may, at its sole discretion, require Xxxxxxx to engage a new IRO in accordance with Paragraph A of this Appendix. Xxxxxxx must engage a new IRO within 60 days of termination of the IRO. Prior to requiring Xxxxxxx to engage a new IRO, OIG shall notify Xxxxxxx of its intent to do so and provide a written explanation of why OIG believes such a step is necessary. To resolve any concerns raised by OIG, Xxxxxxx may present additional information regarding the IRO’s qualifications, independence or performance of its responsibilities. OIG will attempt in good faith to resolve any differences regarding the IRO with Xxxxxxx prior to requiring Xxxxxxx to terminate the IRO. However, the final determination as to whether or not to require Xxxxxxx to engage a new IRO shall be made at the sole discretion of OIG.
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph D, or has failed to carry out its responsibilities as described in Paragraph C, OIG may, at its sole discretion, require Orbit to engage a new IRO in accordance with Paragraph A of this Appendix. Orbit must engage a new IRO within 60 days of termination of the IRO. Prior to requiring Orbit to engage a new IRO, OIG shall notify Orbit of its intent to do so and provide a written explanation of why OIG believes such a step is necessary. To resolve any concerns raised by OIG, Orbit may present additional information regarding the IRO’s qualifications, independence or performance of its responsibilities. OIG will attempt in good faith to resolve any differences regarding the IRO with Orbit prior to requiring Orbit to terminate the IRO. However, the final determination as to whether or not to require Orbit to engage a new IRO shall be made at the sole discretion of OIG.
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph E, or has failed to carry out its responsibilities as described in Paragraph C, OIG shall notify NAHC in writing regarding OIG’s basis for determining that the IRO has not met the requirements of this Appendix. NAHC shall have 30 days from the date of OIG’s written notice to provide information regarding the IRO’s qualifications, independence or performance of its responsibilities in order to resolve the concerns identified by OIG. If, following OIG’s review of any information provided by NAHC regarding the IRO, OIG determines that the IRO has not met the requirements of this Appendix, OIG shall notify NAHC in writing that NAHC shall be required to engage a new IRO in accordance with Paragraph A of this Appendix. NAHC must engage a new IRO within 60 days of its receipt of OIG’s written notice. The final determination as to whether or not to require NAHC to engage a new IRO shall be made at the sole discretion of OIG. APPENDIX B SKILLED NURSING FACILITY CLAIMS REVIEW
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph E, or has failed to carry out its responsibilities as described in Paragraph C, OIG shall notify Xx. Xxx and Interventional Cardiology in writing regarding OIG’s basis for determining that the IRO has not met the requirements of this Appendix. Xx. Xxx and Interventional Cardiology shall have 30 days from the date of OIG’s written notice to provide information regarding the IRO’s qualifications, independence or performance of its responsibilities in order to resolve the concerns identified by OIG. If, following OIG’s review of any information provided by Xx. Xxx and Interventional Cardiology regarding its IRO, OIG determines that the IRO has not met the requirements of this Appendix, OIG shall notify Xx. Xxx and Interventional Cardiology in writing that Xx. Xxx and Interventional Cardiology shall be required to engage a new IRO in accordance with Paragraph A of this Appendix. Xx. Xxx and Interventional Cardiology must engage a new IRO within 60 days of receipt of OIG’s written notice. The final determination as to whether or not to require Xx. Xxx and Interventional Cardiology to engage a new IRO shall be made at the sole discretion of OIG. APPENDIX B QUARTERLY CLAIMS REVIEW
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph D, or has failed to carry out its responsibilities as described in Paragraph C, OIG may, at its sole discretion, require CHSI to engage a new IRO in accordance with Paragraph A of this Appendix. CHSI must engage a new IRO within 60 days of termination of the IRO. Prior to requiring CHSI to engage a new IRO, OIG shall notify CHSI of its intent to do so and provide a written explanation of why OIG believes such a step is necessary. To resolve any concerns raised by OIG, CHSI may present additional information regarding the IRO’s qualifications, independence or performance of its responsibilities. OIG will attempt in good faith to resolve any differences regarding the IRO with CHSI prior to requiring CHSI to terminate the IRO. However, the final determination as to whether or not to require CHSI to engage a new IRO shall be made at the sole discretion of OIG. Community Health Systems, Inc. 3 Corporate Integrity Agreement - Appendix A APPENDIX B INPATIENT MEDICAL NECESSITY AND APPROPRIATENESS REVIEW
OIG Removal of IRO. In the event OIG has reason to believe the IRO does not possess the qualifications described in Paragraph B, is not independent and objective as set forth in Paragraph D, or has failed to carry out its responsibilities as described in Paragraph C, OIG may, at its sole discretion, require Good Shepherd to engage a new IRO in accordance with Paragraph A of this Appendix. Good Shepherd must engage a new IRO within 60 days of termination of the IRO. Prior to requiring Good Shepherd to engage a new IRO, OIG shall notify Good Shepherd of its intent to do so and provide a written explanation of why OIG believes such a step is necessary. To resolve any concerns raised by OIG, Good Shepherd may present additional information regarding the IRO’s qualifications, independence or performance of its responsibilities. OIG will attempt in good faith to resolve any differences regarding the IRO with Good Shepherd prior to requiring Good Shepherd to terminate the IRO. However, the final determination as to whether or not to require Good Shepherd to engage a new IRO shall be made at the sole discretion of OIG.
