Common use of Excluded Providers Clause in Contracts

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 becoming aware of the conviction. 8.8.2.5. Any subcontractor terminated for cause within ten (10) business days of the effective date of termination to include full details of the reason for termination. 8.8.2.6. Any Contractor and subcontractor’s individuals and entities with an ownership or controlling interest. Using the form provided by Great Rivers, the Contractor must submit a list with details of ownership and control no later thirty (30) days from execution of this agreement on the form provided by Great Rivers, and notify Great Rivers of any changes within thirty (30) calendar days. 8.8.3. The Contractor must not make any payments for goods or services that directly or indirectly benefit any excluded individual or entity. The Contractor must immediately recover any payments for goods and services that benefit excluded individuals and entities that it discovers. 8.8.3.1. The Contractor must immediately terminate any employment, contractual, and control relationships with an excluded individual and entity that it discovers. 8.8.3.2. Civil monetary penalties may be imposed against the Contractor if it employs or enters into a contract with an excluded individual or entity to provide goods or services to enrollees (SSA section 1128A(a)(6) and 42 CFR § 1003.200. 8.8.4. An individual or entity is considered to have an ownership or controlling interest if they have direct or indirect ownership of five percent (5%) or more, or are a managing employee (e.g., a general manager, business manager, CEO, or director) who exercises operational or managerial control, or who directly or indirectly conducts day-to-day operations (SSA section 1126(b), 42 CFR 455.104, and 42 CFR 1001.1001(a)(2)). 8.8.4.1. If Great Rivers notifies the Contractor that an individual or entity is excluded from participation, the Contractor must terminate all beneficial, employment and contractual, and control relationships with the excluded individual or entity immediately (WAC 388-877-0500). 8.8.4.2. The list of excluded individuals may be found at 8.8.4.2.1. List of Excluded Individuals and Entities – LEIE: xxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. 8.8.4.2.2. System for Award Management – XXX: xxx.xxx.gov.

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 becoming aware of the conviction. 8.8.2.5. Any subcontractor terminated for cause within ten (10) business days of the effective date of termination to include full details of the reason for termination. 8.8.2.6. Any Contractor and subcontractor’s individuals and entities with an ownership or controlling interest. Using the form provided by Great Rivers, the Contractor must submit a list with details of ownership and control no later thirty (30) days from execution of this agreement on the form provided by Great Rivers, and notify Great Rivers of any changes within thirty (30) calendar days. 8.8.3. The Contractor must not make any payments for goods or services that directly or indirectly benefit any excluded individual or entity. The Contractor must immediately recover any payments for goods and services that benefit excluded individuals and entities that it discovers. 8.8.3.1. The Contractor must immediately terminate any employment, contractual, and control relationships with an excluded individual and entity that it discovers. 8.8.3.2. Civil monetary penalties may be imposed against the Contractor if it employs or enters into a contract with an excluded individual or entity to provide goods or services to enrollees (SSA section 1128A(a)(6) and 42 CFR § 1003.200. 8.8.4. An individual or entity is considered to have an ownership or controlling interest if they have direct or indirect ownership of five percent (5%) or more, or are a managing employee (e.g., a general manager, business manager, CEO, or director) who exercises operational or managerial control, or who directly or indirectly conducts day-to-day operations (SSA section 1126(b), 42 CFR 455.104, and 42 CFR 1001.1001(a)(2)). 8.8.4.1. If Great Rivers notifies the Contractor that an individual or entity is excluded from participation, the Contractor must terminate all beneficial, employment and contractual, and control relationships with the excluded individual or entity immediately (WAC 388246-877341-0500). 8.8.4.2. The list of excluded individuals may be found at 8.8.4.2.1. List of Excluded Individuals and Entities – LEIE: xxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. 8.8.4.2.2. System for Award Management – XXX: xxx.xxx.gov.

Excluded Providers. The Contractor and its subcontractors are is prohibited from paying with funds received under this Agreement for goods and services furnished, ordered, 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 shall 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. 8.8.17.8.1. The Contractor must monitor for excluded individuals and entities by: 8.8.1.17.8.1.1. Screening the Contractor’s and subcontractor’s directors, officersofficer, and partners prior to entering into a contractual or other relationship. 8.8.1.27.8.1.2. Screening individuals and entities with an ownership or controlling control interest of at least five percent (5%) percent of the Contractor’s equity prior to entering into a contractual or other relationship. 8.8.1.37.8.1.3. 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. 8.8.1.47.8.1.4. Screening monthly newly added Contractor and subcontractor’s employees, individuals and entities with an ownership or controlling control interest for excluded individuals and entities that would benefit directly or indirectly from funds received under this AgreementContract. 8.8.1.57.8.1.5. Screening monthly Contractor and subcontractor’s employees, individuals and entities with an ownership or controlling control interest that would benefit from funds received under this Agreement Contract for newly added excluded individuals and entities. 8.8.27.8.2. The Contractor must report to Great RiversDSHS: 8.8.2.17.8.2.1. Any excluded individuals and entities discovered in the screening within ten (10) business days. 8.8.2.27.8.2.2. Any payments made by the Contractor that directly or indirectly benefit excluded individuals and entities and the recovery of such payments. 8.8.2.37.8.2.3. Any actions taken by the Contractor to terminate relationships with Contractor and subcontractor’s employees and individuals with an ownership or controlling control interest discovered in the screening. 8.8.2.47.8.2.4. Any Contractor and subcontractor’s employees and individuals with an ownership or controlling control interest convicted of any criminal or civil offense described in Social Security Act (SSA) SSA section 1128 within ten (10) business days of the Contractor becoming aware of the conviction. 8.8.2.57.8.2.5. Any subcontractor terminated for cause within ten (10) business days of the effective date of termination to include full details of the reason for termination. 8.8.2.67.8.2.6. Any Contractor and subcontractor’s individuals and entities with an ownership or controlling control interest. Using the form provided by Great Rivers, the The Contractor must submit provide a list with details of ownership and control no later thirty (30) days from execution of this agreement on the form provided by Great Riversthan August 31, 2015, and notify Great Rivers DSHS of any changes within thirty (30) 30 calendar days. 8.8.37.8.3. The Contractor must will not make any payments for goods or services that directly or indirectly benefit any excluded individual or entity. The Contractor must will immediately recover any payments for goods and services that benefit excluded individuals and entities that it discovers. 8.8.3.17.8.3.1. The Contractor must will immediately terminate any employment, contractual, and control relationships with an excluded individual and entity that it discovers. 8.8.3.27.8.3.2. Civil monetary penalties may be imposed against the Contractor if it employs or enters into a contract with an excluded individual or entity to provide goods or services to enrollees Enrollees. (SSA section 1128A(a)(6) and 42 CFR § 1003.2001003.102(a)(2)). 8.8.47.8.4. An individual or entity is considered to have an ownership or controlling control interest if they have direct or indirect ownership of five 5 percent (5%) or more, or are a managing employee (e.g., a general manager, business manager, CEOadministrator, or director) who exercises operational or managerial control, or who directly or indirectly conducts day-to-day operations (SSA section 1126(b), 42 CFR 455.104455.104(a), and 42 CFR 1001.1001(a)(21001.1001(a)(1)). 8.8.4.17.8.4.1. If Great Rivers In addition, if DSHS notifies the Contractor that an individual or entity is excluded from participationparticipation by DSHS in RSN’s, the Contractor must shall terminate all beneficial, employment and contractual, and control relationships with the excluded individual or entity immediately (WAC 388000- 000-877-05000000). 8.8.4.27.8.4.2. The list of excluded individuals may be found at 8.8.4.2.1at: xxxxx://xxx.xxx.xxx/exclusions/. 7.8.4.3. List of Excluded Individuals and Entities – LEIESSA section 1128 may be found at: xxxx://xxx.xxx.xxx.xxx/fraud/xxxxxxxxxx.xxx. 8.8.4.2.2. System for Award Management – XXX: xxx.xxx.govxxxx://xxx.xxx.xxx/OP_Home/ssact/title11/1128.htm.