Fraud/Abuse and Office Visits Sample Clauses

Fraud/Abuse and Office Visits. Upon the request of the CMS, the DHHS, the MAP, or any appropriate external review organization or regulatory agency (“Oversight Entities”) PROVIDER shall make available for audit, all administrative, financial, medical, and all other records that relate to the delivery of items or services under this Agreement. PROVIDER shall provide all such access to the aforementioned records in the form and format requested and at no cost to XXXXX and/or to the requesting Oversight Entity. Further, the PROVIDER shall cooperate with and allow such Oversight Entities access to these records during normal business hours, except under special circumstances when PROVIDER shall permit after hour access. PROVIDER shall cooperate with all office visits made by XXXXX or any Oversight Entity.
Sample 1Sample 2Sample 3See All (11)
AutoNDA by SimpleDocs
Fraud/Abuse and Office Visits. Upon the request of the DHHS, the NC DHHS, the DMA, or other appropriate external review organization or regulatory agency (“Oversight Entities”) PROVIDER shall make available for audit, all administrative, financial, medical, and all other records that relate to the delivery of items or services under this Agreement. Further, the PROVIDER shall cooperate with and allow such Oversight Entities access to these records during normal business hours, except under special circumstances when PROVIDER shall permit after hours admissions. PROVIDER shall cooperate with all office visits made by XXXXX or any Oversight Entity.
Sample 1Sample 2
Fraud/Abuse and Office Visits. Upon the request of the CMS, the DHHS, the MAP, or other appropriate external review organization or regulatory agency (“Oversight Entities”) PROVIDER shall make available for audit, all administrative, financial, medical, and all other records that relate to the delivery of items or services under this Agreement. PROVIDER shall provide all such access to the aforementioned records at no cost to XXXXX and/or to the requesting Oversight Entity, and in the form and format requested. Further, the PROVIDER shall cooperate with and allow such Oversight Entities access to these records during normal business hours, except under special circumstances when PROVIDER shall permit after hours access. PROVIDER shall cooperate with all office visits made by XXXXX or any Oversight Entity. Lack of records or falsification of records may be cause for a referral to the appropriate law enforcement agency for further action. PROVIDERS are subject to State and federal laws pertaining to penalties for vendor fraud and kickbacks.
Sample 1
Fraud/Abuse and Office Visits. Upon the request of the CMS, the DHHS, the HHSC, the MAP, or other appropriate external review organization or regulatory agency (“Oversight Entities”) PROVIDER shall make available all administrative, financial, medical, and all other records that relate to the delivery of items or services under this Agreement. PROVIDER shall provide all such access to the aforementioned records at no cost to XXXXX and/or to the requesting Oversight Entity, and in the form and format requested. PROVIDER shall allow such Oversight Entities access to these records during normal business hours, except under special circumstances when PROVIDER shall permit after hours access. PROVIDER shall cooperate with all office visits made by XXXXX or any Oversight Entity. PROVIDER shall permit and/or make available to the HHSC Office of the Inspector General and/or the Texas Medicaid Fraud Control Unit, its employees, agents, (sub)contractors, and patients, for private, in–person interviews, or for consultations, jury proceedings, pre-trial conferences, hearings, trials and such other processes as may be necessary to conduct such Oversight Entity’s investigation. PROVIDER understands and agrees the acceptance of funds under this Agreement acts as acceptance of the authority of the Texas State Auditor’s Office (“SAO”), or any successor agency, to conduct an investigation in connection with those funds. PROVIDER agrees to cooperate fully with the SAO or its successor in the conduct of the audit or investigation, including providing all records requested. PROVIDER further understands and agrees he/she/it is bound to report any suspected fraud or abuse, including any suspected fraud and abuse committed by the Plan or a Member, to the HHSC Office of the Inspector General. PROVIDER’s obligations contained herein shall survive termination of this Agreement.
Sample 1
Fraud/Abuse and Office Visits. Upon the request of the CMS, the DHHS, the MAP, or other appropriate external review organization or regulatory agency (“Oversight Entities”) PROVIDER shall make available all administrative, financial, medical, and all other records that relate to the delivery of items or services under this Agreement. Further, the PROVIDER shall allow such Oversight Entities access to these records during normal business hours, except under special circumstances when PROVIDER shall permit after hours access. PROVIDER shall cooperate with all office visits made by XXXXX or any Oversight Entity.
Sample 1

Related to Fraud/Abuse and Office Visits

  • Fraud, Xxxxx and Abuse If you have concerns about being billed for services you never received, or that your insurance information has been stolen or used by someone else, you may report potential health care fraud, waste or abuse to our Special Investigations Unit by using our confidential anti-fraud hotline at 0-000-000-0000 or by email at XXX@xxxxxx.xxx. You may also send an anonymous letter to us at: Blue Cross & Blue Shield of Rhode Island Special Investigations Unit 000 Xxxxxxxx Xxxxxx Providence RI, 02903

  • Compliance with the Communications Assistance Law Enforcement Act of 1994

  • Fraud and Abuse The Company, the Shareholders and all persons and entities providing professional services for the Company's business have not, to the knowledge of the Company and the Shareholders, engaged in any activities which are prohibited under ss. 1320a-7b or ss. 1395nn of Title 42 of the United States Code or the regulations promulgated thereunder, or related state or local statutes or regulations, or which are prohibited by rules of professional conduct, including, but not limited to, the following: (a) knowingly and willfully making or causing to be made a false statement or representation of a material fact in any application for any benefit or payment; (b) knowingly and willfully making or causing to be made any false statement or representation of a material fact for use in determining rights to any benefit or payment; (c) any failure by a claimant to disclose knowledge of the occurrence of any event affecting the initial or continued right to any benefit or payment on its own behalf or on behalf of another, with the intent to fraudulently secure such benefit or payment; and (d) knowingly and willfully soliciting or receiving any remuneration (including any kickback, bribe or rebate) directly or indirectly, overtly or covertly, in cash or in kind, or offering to pay or receive such remuneration (i) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part by Medicare or Medicaid, or (ii) in return for purchasing, leasing or ordering or arranging for, or recommending, purchasing, leasing or ordering any good, facility, service or item for which payment may be made in whole or in part by Medicare or Medicaid, or (e) referring a patient for designated health services to or providing designated health services to a patient upon referral from an entity or person with which the orthodontist or an immediate family member has a financial relationship, and to which no exception under ss.1395nn of Title 42 of the United States Code applies.

  • 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

  • Office Visit Copayments In each year of the Agreement, the level of the office visit copayment applicable to an employee and dependents is based upon whether the employee has completed the on-line Health Assessment during open enrollment and has agreed to opt-in for health coaching.

  • Rights Protection Mechanisms and Abuse Mitigation ­‐ Registry Operator commits to implementing and performing the following protections for the TLD:

  • General Requirements for Insurance Coverage and Policies A. All required insurance policies shall be maintained with companies that may lawfully issue the required policy and have an A.M. Best rating of at least A- / “VII” or a Standard and Poor’s rating of at least A, unless prior written approval is obtained from the City Law Department.

  • Health Insurance Portability and Accountability Act Grantee certifies that it is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law Xx. 000-000, 00 XXX Parts 160, 162 and 164, and the Social Security Act, 42 USC 1320d-2 through 1320d-7, in that it may not use or disclose protected health information other than as permitted or required by law and agrees to use appropriate safeguards to prevent use or disclosure of the protected health information. Grantee shall maintain, for a minimum of six (6) years, all protected health information.

  • COMPLIANCE WITH NEW YORK STATE INFORMATION SECURITY BREACH AND NOTIFICATION ACT Contractor shall comply with the provisions of the New York State Information Security Breach and Notification Act (General Business Law Section 899-aa; State Technology Law Section 208).

  • INSURANCE and INDEMNIFICATION REQUIREMENTS See Exhibit C, attached hereto, for insurance requirements for this Agreement. The COUNTY’S insurance requirements are a material provision to this Agreement.

Time is Money Join Law Insider Premium to draft better contracts faster.