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3.4.2 Provider shall make all records, including, but not limited to, financial, administrative and medical
<br />records available at Provider's expense, Including computerized data stored by Provider, to any duly
<br />authorized government agency, including, but not limited to, HCA, CMS, OIG, MFCU, HHS, DOJ and
<br />the Office of the Comptroller of the Treasury, upon any authorized government agency's request for
<br />administrative, civil and/or criminal review, audit, evaluation, inspection, investigation and/or
<br />prosecution. HCA, CMS, OIG, MFCU, HHS, DOJ and the Office of the Comptroller of the Treasury,
<br />as well as any authorized state or federal agency or entity shall have the right to evaluate through
<br />inspection, evaluation, review or request, whether announced or unannounced, or other means, any
<br />record pertinent to this Attachment, including but not limited to medical records, billing records,
<br />financial records, and/or any records related to services rendered, quality, appropriateness and
<br />timeliness of services and/or any records relevant to an administrative, civil and/or criminal
<br />investigation and/or prosecution, and such evaluation, inspection, review or request, when performed
<br />or requested, shall be performed with the immediate cooperation of the Provider. Requested records
<br />shall be provided at no expense to Agency personnel, including representatives from HCA, OIG, the
<br />MFCU, DOJ and the HHS, or any duly authorized state or federal agency. Upon request, the Provider
<br />shall assist in such reviews, and provide complete copies of medical records. Any authorized
<br />government agency, including but not limited to, HCA, CMS, OIG, MFCU, HHS, DOJ and the Office
<br />of the Comptroller of the Treasury, may use these records to cant' out their authorized duties,
<br />reviews, audits, administrative, civil and/or criminal investigations and/or prosecutions. Provider shall
<br />cooperate fully in any audit, investigation or review by Wellpoint, State Agency, MPI, MFCU, or other
<br />state or federal entity and in any subsequent legal action that may result from such an audit,
<br />investigation or review involving this Attachment, including promptly supplying all data and
<br />information requested for such investigation; provided that nothing in this section shall be construed
<br />to limit a Provider's right to defend its actions in any legal proceeding in accordance with its rights
<br />under the law.
<br />3.4.3 The right for the parties named above to audit, access and inspect under this section exists for ten
<br />(10) years from the final date of the Attachment period or from the date of completion of any audit,
<br />whichever is later, or any other timeframe authorized by law
<br />3.4.4 Provider will have the right to audit Wellpoint records relating to Medicaid Covered Services rendered
<br />by Provider to Medicaid Members.
<br />3.5 Encounter Data. If Provider is paid on a capitated basis, Provider shall timely submit complete and accurate
<br />encounter data for capitated services rendered to Medicaid Members, including, without limitation, statistical
<br />and descriptive medical, diagnostic and patient data for Medicaid Covered Services rendered to Medicaid
<br />Members, to meet the encounter data reporting requirements set forth in the Government Contract.
<br />ARTICLE IV
<br />COMPLIANCE WITH FEDERAL REGULATORY REQUIREMENTS
<br />4.1 Federal Funds. Provider acknowledges that payments Provider receives from Plan to provide Medicaid
<br />Covered Services to Medicaid Members are, in whole or part, from federal funds. Therefore, Provider and any
<br />of his/her/its subcontractors are subject to certain laws that are applicable to individuals and entities receiving
<br />federal funds, which may include but are not limited to, Title VI of the Civil Rights Act of 1964 as implemented
<br />by 45 CFR Part 80; the Age Discrimination Act of 1975 as implemented by 45 CFR Part 91; the Americans
<br />with Disabilities Act as implemented by 28 CFR Part 35; the Rehabilitation Act of 1973 as implemented by 45
<br />CFR Part 84, lobbying restrictions as implemented by 45 CFR Part 93 and 31 USC 1352, Title IX of the
<br />Education Amendments of 1972, as amended (20 U.S.C. sections 1681, 1685-1686, and 1783) and any other
<br />regulations applicable to recipients of federal funds.
<br />4.2 Surety Bond Requirement. If Provider provides home health services or durable medical equipment, Provider
<br />shall comply with all applicable provisions of Section 4724(b) of the Balanced Budget Act of 1997, including,
<br />without limitation, any applicable requirements related to the posting of a surety bond.
<br />4.3 Laboratory Compliance. If Provider renders lab services in the office, it must maintain a valid Clinical
<br />Laboratory Improvement Amendments ("CLIX) certificate for all laboratory testing sites and comply with CLIA
<br />regulations at 42 CFR Part 493 for all laboratory testing sites performing Health Services pursuant to this
<br />Attachment.
<br />ARTICLE V
<br />COMPLIANCE WITH STATE REGULATORY REQUIREMENTS
<br />Washington Enterprise Provider Agreement Medicaid Attachment 21 1183932156
<br />a 2024 July— Werpoinl Washington, Inc. 05/05/2025
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