Excluded Providers. 4.1 Definition of Excluded Providers
Excluded Providers i. The Contractor shall not employ or subcontract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act.
Excluded Providers. 12.1 Vendor represents and warrants that Vendor and Vendor Employees are not individuals or entities excluded from participation in federal or state health care programs. Vendor shall ensure the eligibility of Vendor and Vendor Employees to participate in federal and state health care programs and further warrants that it will notify NYC Health + Hospitals in writing if Vendor or any Vendor Employees become excluded from such participation during the term of this Agreement. NYC Health + Hospitals may terminate this Agreement immediately without liability for any damages resulting therefrom should Vendor or Vendor Employees be excluded from participation in federal or state health care programs.
12.2 Vendor warrants that it is not currently a party to a Corporate Integrity Agreement or Certification of Compliance Agreement with any state or federal governmental agency. Vendor shall promptly notify NYC Health + Hospitals if it becomes a party to such agreement during the term of this Agreement.
Excluded Providers. Pursuant to 42 CFR 438.214(d), the Contractor shall not employ or contract with Providers that are Excluded from participation in Federal Health Care Programs under either Section 1128 or 1128A of the Social Security Act.
Excluded Providers. The Contractor shall screen and periodically revalidate all network providers in accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
Excluded Providers. This agreement does NOT cover health care services performed by a provider who has been excluded or debarred from participation in Federal programs, such as Medicare and Medicaid. To determine whether a provider has been excluded from a Federal program, visit the U.S. Department of Human Services Office of Inspector General website (xxxxx://xxxxxxxxxx.xxx.xxx.xxx/) or the Excluded Parties List System Web site maintained by the U.S. General Services Administration (xxxxx://xxx.xxx.gov/).
Excluded Providers. A. The Contractor shall screen and periodically revalidate all network providers in accordance with the requirements of 42 Code of Federal Regulations, part 455, subparts B and E. (42 C.F.R. §438.602(b).)
B. Consistent with the requirements of 42 Code of Federal Regulations, part 455.436, the Contractor must confirm the identity and determine the exclusion status of all providers (employees and network providers) and any subcontractor, as well as any person with an ownership or control interest, or who is an agent or managing employee of the of the Mental Health Plan through routine checks of Federal and State databases. This includes the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE), the System for Award Management (XXX), as well as the Department’s Medi Cal Suspended and Ineligible Provider List (S & I List). (42 C.F.R. §438.602(d).)
C. If the Contractor find a party that is excluded, it must promptly notify the Department (42 C.F.R. §438.608(a)(2),(4)) and the Department will take action consistent with 42 C.F.R. §438.610((d). The Contractor shall not certify or pay any excluded provider with Medi-Cal funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority.
Excluded Providers. The Office of Inspector General (“OIG”) Special Advisory Bulletin on the Effect of Exclusions on Participation in Federal Health Care Programs clarifies OIG’s sanction authority to impose civil money penalties and deny reimbursement under federal health care programs for products or services provided by an excluded entity. Specifically, it provides that “items or equipment sold by an excluded manufacturer or supplier used in the care or treatment of beneficiaries and reimbursed, directly or indirectly, by a federal health care program violate the OIG’s exclusion.” ABDC certifies that neither it, nor any of its key personnel, are listed by a federal agency as being debarred, excluded, or otherwise ineligible for federal program participation as of the Effective Date and ABDC will immediately notify Customer in writing if any of these events occurs.
Excluded Providers. The Contractor and its subcontractors are prohibited from paying with funds received under this Agreement for goods and services furnished, ordered, or prescribed by excluded individuals and entities: (Social Security Act (SSA) Section 1903(i)(2); 42 CFR § 455.104; 42 CFR 455.106; and 42 CFR § 1001.1901(b). In addition, the Contractor must ensure that it does not employ or contract with anyone that is excluded from participation in Federal health care programs under Section 1128 or Section 1128A of the SSA, Executive Order 12549 or 45 CFR § 92.35.
8.8.1. The Contractor must monitor for excluded individuals and entities by:
8.8.1.1. Screening the Contractor’s and subcontractor’s directors, officers, and partners prior to entering into a contractual or other relationship.
8.8.1.2. Screening individuals and entities with an ownership or controlling interest of at least five percent (5%) of the Contractor’s equity prior to entering into a contractual or other relationship.
8.8.1.3. Screening individuals with an employment, consulting, or other arrangement with the Contractor for the provision of items and services that are significant and material to the Contractor’s obligations under this Agreement.
8.8.1.4. Screening monthly newly added Contractor and subcontractor’s employees, individuals and entities with an ownership or controlling interest for excluded individuals and entities that would benefit directly or indirectly from funds received under this Agreement.
8.8.1.5. Screening monthly Contractor and subcontractor’s employees, individuals and entities with an ownership or controlling interest that would benefit from funds received under this Agreement for newly added excluded individuals and entities.
8.8.2. The Contractor must report to Great Rivers:
8.8.2.1. Any excluded individuals and entities discovered in the screening within ten (10) business days.
8.8.2.2. Any payments made by the Contractor that directly or indirectly benefit excluded individuals and entities and the recovery of such payments.
8.8.2.3. Any actions taken by the Contractor to terminate relationships with Contractor and subcontractor’s employees and individuals with an ownership or controlling interest discovered in the screening.
8.8.2.4. Any Contractor and subcontractor’s employees and individuals with an ownership or controlling interest convicted of any criminal or civil offense described in Social Security Act (SSA) section 1128 within ten (10) business days of the Contractor ...
Excluded Providers. Each Party represents, warrants and covenants to other Party that, during the term of the Agreement, it and each of its employees, contractors and/or agents providing services hereunder has not been: (a) convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a- 7(a); or (b) excluded, debarred, suspended or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or non-procurement programs. Without limiting the foregoing, each Party agrees to use its reasonable efforts to check, before hiring staff and every thirty (30) days thereafter, all of its employees, contractors and/or agents providing services hereunder whose salaries are directly or indirectly paid for by a federal health care program against the exclusion lists maintained by the following: (v) the US Department of Health and Human Services’ Office of Inspector General; (w) the System for Award Management (“XXX”) ; (x) the New York State Office of Medicaid Inspector General; (y) Social Security Death Master; and (z) the Office of Foreign Asset Control. Each Party shall promptly notify the other Party in writing in the event that it becomes aware that it or any of its employees, contractors, or agents providing services hereunder appear on one or more of these lists and shall immediately remove such sanctioned person from providing services to or on behalf of the other Party. Either Party shall have the right to immediately terminate this Agreement upon written notice to the other Party if the other Party appears on one of the foregoing lists. Each Party represents and warrants that it is not currently a party to a Corporate Integrity Agreement ("CIA") or Certification of Compliance
