Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is: a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person. ii) Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 5 contracts
Samples: Provider Agreement, Arizona Medicaid Comprehensive Medical and Dental Program Regulatory Requirements Appendix, Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially its employees and on an ongoing monthly basis contractors to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion listsexcluded. Provider shall immediately report to United Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases Subcontractor must be reviewed monthly to ensure that no employee or contractor has been excluded. United will terminate the Agreement immediately and exclude from its network any provider who has been terminated excluded from the Medicare, Medicare or Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 5 contracts
Samples: Kansas Medicaid and Chip Regulatory Requirements Appendix, Kansas Medicaid and Chip Regulatory Requirements Appendix, Individual Participating Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief represents that neither it nor any of its principals, employees, principals, nor any providers, subcontractors or subcontractors, consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs by the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) under either Section 1128 or section Section 1128A of the Social Security Act, or excluded from participation by the DHS in the State Program; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order noNo. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis as required under 42 CFR §1001.1901(b) to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Health Plan and Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or Medicaid or CHIP program in any state. United Subcontractor may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list. Provider shall cooperate with Health Plan and Subcontractor and comply with all disclosure requirements identified in accordance with 42 CFR Part 455, Subpart B and the State Contract within thirty-five (35) days of the date on a request by Health Plan, Subcontractor, or DHS.
Appears in 4 contracts
Samples: Provider Agreement, Hawaii State Programs Regulatory Requirements Appendix, Hawaii State Programs Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially its employees and on an ongoing monthly basis contractors to determine whether any of them have been debarred or excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion listsexcluded. Provider shall immediately report to United Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Applicable state exclusion databases can be accessed through the State’s Medicaid website. Subcontractor and/or Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United Subcontractor and/or Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 3 contracts
Samples: Medicaid Provider Agreement, Medicaid Provider Agreement, Medicaid Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii. Provider acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR 1001.1901(b) Provider and is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR 1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and/or Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Applicable state exclusion databases must can be reviewed monthly to ensure that no employee or contractor has been excludedaccessed through the State’s Medicaid website. United Subcontractor and Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or the Medicaid or CHIP program in any state. United Subcontractor and Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 3 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United Subcontractor may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 2 contracts
Samples: Arizona Acc Medicaid and Chip Program Regulatory Requirements Appendix, Downstream Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principalsprincipals or owners, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this the Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Health Plan and Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Health Plan and Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been excluded or has been terminated from the Medicare, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 2 contracts
Samples: Downstream Provider Medicaid Program Regulatory Requirements Appendix, Downstream Provider Medicaid Program Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended suspended, proposed for debarment, declared ineligible, or otherwise voluntarily excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement non-procurement activities under regulations issued under Executive Order noNo. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees and shall require that Provider acknowledge and agree that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Member under this the Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under the Agreement. Provider shall immediately report to United Subcontractor and/or CCO any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Applicable state exclusion databases must can be reviewed monthly to ensure that no employee or contractor has been excludedaccessed through the State’s Medicaid website. United Subcontractor will terminate the Agreement immediately and exclude upon becoming aware or receiving notice from its network any provider who has been terminated from the MedicareDOM, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or whichever is earlier, that Provider’s owners, agents, managing employees, or managing employees are found to be any provider is or has been excluded on from federal health care programs or terminated from the state Medicare or federal exclusion listthe Medicaid program in any state.
Appears in 2 contracts
Samples: Provider Agreement, Mississippichip Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Applicable state exclusion databases can be accessed through the State’s Medicaid website. Subcontractor and/or Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United Subcontractor and/or Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 2 contracts
Samples: Pennsylvania Government Programs Regulatory Requirements Appendix, Pennsylvania Government Programs Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, agents, employees, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; , or;
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially its employees and on an ongoing monthly basis contractors to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion listsexcluded. Provider shall immediately report to United Health Plan and/or Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Health Plan and/or Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been terminated excluded from the Medicare, Medicare or Medicaid or CHIP program in any state. United may Provider is also terminate obligated to screen m o n t h l y all employees against, including those providing direct services to Covered Persons (e.g., home health, personal care), in accordance with the Agreement if Provider or Provider’s ownersEmployee Abuse Registry Act, agentsNMSA 1978, or managing § 27-7A-3, the New Mexico Caregivers Criminal History Screening Act, NMSA 1978, 29-17-2 et seq., and ensure that all employees are found to be excluded on screened against the state or federal New Mexico “List of Excluded Individuals/Entities” and the Medicare exclusion listdatabases. Provider shall further comply with 42 CFR § 438.08 regarding exclusion of entities, including all statutes and regulations referenced therin.
Appears in 2 contracts
Samples: New Mexico Centennial Care Regulatory Requirements Appendix, New Mexico Centennial Care Regulatory Requirements Appendix
Excluded Individuals and Entities. (i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
(ii) Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Health Plan and/or Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Health Plan and/or Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United Health Plan and/or Subcontractor may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 2 contracts
Samples: Arizona Medicaid Developmentally Disabled Program Regulatory Requirements Appendix, Arizona Medicaid and Chip Program Regulatory Requirements Appendix
Excluded Individuals and Entities. i(a) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
a(i) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
b(ii) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii(b) Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Health Plan and/or Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Health Plan and/or Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or Medicaid or CHIP program in any state. United Health Plan and/or Subcontractor may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 2 contracts
Samples: Arizona CRS State Program Regulatory Requirements Appendix, Arizona Long Term Care Program Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
ai) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
bii) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Applicable state exclusion databases can be accessed through the State’s Medicaid website. Subcontractor and/or Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United Subcontractor and/or Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Pennsylvania Government Programs Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principalsprincipals or owners, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this the Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Health Plan and Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal Health Plan and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been excluded or has been terminated from the Medicare, Medicare or Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 1 contract
Samples: Downstream Provider Medicaid Program Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Applicable state exclusion databases must can be reviewed monthly to ensure that no employee or contractor has been excludedaccessed through the State’s Medicaid website. United Subcontractor and Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or the Medicaid or CHIP program in any state. United Subcontractor and Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Applicable state exclusion databases can be accessed through the State’s Medicaid website. Subcontractor and/or Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicaid or CHIP program in any state. United Subcontractor and/or Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Applicable state exclusion databases can be accessed through the State’s Medicaid website. Subcontractor and/or Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United Subcontractor and/or Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Provider Agreement
Excluded Individuals and Entities. i) By x. Xx signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list.
Appears in 1 contract
Samples: Arizona Long Term Care Program Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief represents that neither it nor any of its principals, employees, principals, nor any providers, subcontractors or subcontractors, consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs by the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) under either Section 1128 or section Section 1128A of the Social Security Act, or excluded from participation by the DHS in the State Programs; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order noNo. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under 42 CFR §1001.1901(b) to screen all employees, contractors, and/or subcontractors initially and on an ongoing monthly basis as required under 42 CFR §1001.1901(b) to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion lists. Provider shall immediately report to United Health Plan and Subcontractor any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Subcontractor will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or Medicaid or CHIP program in any state. United Subcontractor may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state or federal exclusion list. Provider shall cooperate with Health Plan and Subcontractor and comply with all disclosure requirements identified in accordance with 42 CFR Part 455, Subpart B and the State Contract within thirty-five (35) days of the date on a request by Health Plan, Subcontractor , or DHS.
Appears in 1 contract
Samples: Hawaii State Programs Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
ai) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
bii) debarred, suspended suspended, proposed for debarment, declared ineligible, or otherwise voluntarily excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement non-procurement activities under regulations issued under Executive Order noNo. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees and shall require that Provider acknowledge and agree that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Member under this the Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under the Agreement. Provider shall immediately report to United CCO any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United Applicable state exclusion databases can be accessed through the State’s Medicaid website. CCO will terminate the Agreement immediately and exclude upon becoming aware or receiving notice from its network any provider who has been terminated from the MedicareDOM, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or whichever is earlier, that Provider’s owners, agents, managing employees, or managing employees are found to be any provider is or has been excluded on from federal health care programs or terminated from the state Medicare or federal exclusion listthe Medicaid program in any state.
Appears in 1 contract
Samples: Mississippichip Program Regulatory Requirements Appendix
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
ai) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
bii) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and Provider is obligated to screen all employees, contractors, and/or subcontractors initially its employees and on an ongoing monthly basis contractors to determine whether any of them have been excluded from participation in Medicare, Medicaid, CHIP, or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded to provide items or Covered Services under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state or federal exclusion listsexcluded. Provider shall immediately report to United any exclusion information discovered. Provider acknowledges and agrees that pursuant to 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Applicable state exclusion databases can be accessed through the State’s Medicaid website. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. United will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR§1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. Applicable state exclusion databases can be accessed through the State’s Medicaid website. United will terminate the Agreement immediately and exclude from its network any provider who has been terminated from the Medicare, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United Subcontractor and Health Plan any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. Federal and State The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Applicable state exclusion databases must can be reviewed monthly to ensure that no employee or contractor has been excludedaccessed through the State’s Medicaid website. United Subcontractor and/or Health Plan will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicare or the Medicaid or CHIP program in any state. United Subcontractor and/or Health Plan may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Provider Agreement
Excluded Individuals and Entities. i) By signing the Agreement, Provider certifies to the best of Provider’s knowledge and belief that neither it nor any of its employees, principals, nor any providers, subcontractors or consultants or persons with an ownership or controlling interest in the Provider (an owner including the Provider himself or herself), or an agent or managing employee of the Provider, with whom Provider contracts and who are providing items or services that are significant and material to Provider’s obligations under the Agreement is:
(a) excluded from participation in federal health care programs under either Section 1128 or section 1128A of the Social Security Act; or
(b) debarred, suspended or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order no. 12549 or under guidelines implementing Executive Order No. 12549; or an affiliate, as defined in the Federal Acquisition Regulation, of such a person.
ii) . Provider is obligated under acknowledges and agrees that payment will not be made for any items or Covered Services provided by an excluded individual pursuant to 42 CFR §1001.1901(b) and is obligated to screen all employees, contractors, and/or and subcontractors initially for exclusion as required under applicable State and on an ongoing monthly basis Federal laws. Additionally, Provider acknowledges that pursuant to determine whether any of them have been 42 CFR §1003.102(a)(2) civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded from participation in Medicare, Medicaid, CHIP, individuals or any Federal Health Care Programs (as defined in Section 1128B(f) of the Social Security Act). Provider shall not employ or contract with an individual or entity that has been excluded entities to provide items or Covered Services to Covered Persons under this Agreement. Provider agrees not to employ or subcontract with individuals or entities whose owner, those with a controlling interest, or managing employees are on any state a State or federal Federal exclusion listslist to provide items or Covered Services under this Agreement. Provider shall immediately report to United any exclusion information discovered. Provider acknowledges and agrees that civil monetary penalties may be imposed against Provider if he or she employs or enters into contracts with excluded individuals or entities to provide items or Covered Services. Provider can search the HHS-OIG website, at no cost, by the names of any individuals or entities. The database is called LEIE and can be accessed at xxxx://xxx.xxxxxxxx.xxx/fraud/xxxxxxxxxx.xxxxxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. The GSA EPLS/XXX database can be accessed at xxxxx://xxx.xxx.gov. Federal and State exclusion databases must be reviewed monthly to ensure that no employee or contractor has been excluded. Applicable state exclusion databases can be accessed through the State’s Medicaid website. United will terminate the Agreement immediately and exclude from its network any provider who has been excluded from federal health care programs or terminated from the Medicare, Medicaid or CHIP program in any state. United may also terminate the Agreement if Provider or Provider’s owners, agents, or managing employees are found to be excluded on the state a State or federal Federal exclusion list.
Appears in 1 contract
Samples: Provider Agreement