Common use of Grounds for action Clause in Contracts

Grounds for action. The Department may terminate a Provider’s Agreement and seek reimbursement from that Provider if the Department determines that the Provider, owner of the Provider, or an employee or agent of the Provider has done any of the following: 1. Submitted false or fraudulent claims to the CRDP. 2. Failed to comply with any term of this Agreement. 3. Been precluded or excluded, either voluntarily or involuntarily, as a Medical Assistance or Medicare provider. 4. Been convicted of a Medicaid or Medicare related criminal offense. 5. Been convicted of a criminal offense under state or Federal laws relating to the services covered by this Agreement. 6. Been subject to license suspension or revocation following disciplinary action entered against the Provider or its health care providers providing services under this Agreement by a licensing or certifying authority. 7. Had a controlled drug license withdrawn or failed to report to the Department changes in the Provider’s Drug Enforcement Agency Number. 8. Knowingly submitted a fraudulent or erroneous patient application or assisted a patient to do so. 9. Refused to permit authorized state or Federal officials or their agents to examine the Provider’s medical, fiscal or other records as necessary to verify claims made to the Department under this Agreement. This section supplements but does not replace paragraph 27 of Appendix C (Standard General Terms and Conditions, Rev. 2/21).

Grounds for action. The Department may terminate a Provider’s Agreement and seek reimbursement from that Provider if the Department determines that the Provider, owner of the Provider, or an employee or agent of the Provider has done any of the following: 1. a. Submitted false or fraudulent claims to the CRDP.HIP; 2. b. Failed to comply with any term of this Agreement.; 3. c. Been precluded or excluded, either voluntarily or involuntarily, as a Medical Assistance or Medicare provider.; 4. d. Been convicted of a Medicaid or Medicare related criminal offense.; 5. e. Been convicted of a criminal offense under state or Federal laws relating to the services covered by this Agreement.; 6. f. Been subject to license suspension or revocation following disciplinary action entered against the Provider or its health care providers providing services under this Agreement by a licensing or certifying authority.; 7. g. Had a controlled drug license withdrawn or failed to report to the Department changes in the Provider’s Drug Enforcement Agency Number.; 8. h. Knowingly submitted a fraudulent or erroneous patient application or assisted a patient to do so.; 9. Refused i. Refusal to permit authorized state or Federal federal officials or their agents to examine the Provider’s medical, fiscal or other records as necessary to verify claims made to the Department under this Agreement. This section supplements but does not replace paragraph 27 of Appendix C (the Standard General Terms and Conditions, (Rev. 2/211/19), which are incorporated herein by reference.

Grounds for action. The Department may terminate a Provider’s Agreement and seek reimbursement from that Provider if the Department determines that the Provider, owner of the Provider, or an employee or agent of the Provider has done any of the following: 1. a. Submitted false or fraudulent claims to the CRDPHIP. 2. b. Failed to comply with any term of this Agreement. 3. c. Been precluded or excluded, either voluntarily or involuntarily, as a Medical Assistance or Medicare provider. 4. d. Been convicted of a Medicaid or Medicare related criminal offense. 5. e. Been convicted of a criminal offense under state or Federal laws relating to the services covered by this Agreement. 6. f. Been subject to license suspension or revocation following disciplinary action entered against the Provider or its health care providers providing services under this Agreement by a licensing or certifying authority. 7. g. Had a controlled drug license withdrawn or failed to report to the Department changes in the Provider’s Drug Enforcement Agency Number. 8. h. Knowingly submitted a fraudulent or erroneous patient application or assisted a patient to do so. 9. Refused i. Refusal to permit authorized state or Federal federal officials or their agents to examine the Provider’s medical, fiscal or other records as necessary to verify claims made to the Department under this Agreement. This section supplements but does not replace paragraph 27 of Appendix C (the Standard General Terms and Conditions, (Rev. 2/213/15), which are incorporated herein by reference.

Grounds for action. The Department may terminate a Provider’s Agreement and seek reimbursement from that Provider if the Department determines that the Provider, owner of the Provider, or an employee or agent of the Provider has done any of the following: 1. a. Submitted false or fraudulent claims to the CRDP.HIP; 2. b. Failed to comply with any term of this Agreement.; 3. c. Been precluded or excluded, either voluntarily or involuntarily, as a Medical Assistance or Medicare provider.; 4. d. Been convicted of a Medicaid or Medicare related criminal offense.; 5. e. Been convicted of a criminal offense under state or Federal laws relating to the services covered by this Agreement.; 6. f. Been subject to license suspension or revocation following disciplinary action entered against the Provider or its health care providers providing services under this Agreement by a licensing or certifying authority.; 7. g. Had a controlled drug license withdrawn or failed to report to the Department changes in the Provider’s Drug Enforcement Agency Number.; 8. h. Knowingly submitted a fraudulent or erroneous patient application or assisted a patient to do so.; 9. Refused i. Refusal to permit authorized state or Federal officials or their agents to examine the Provider’s medical, fiscal or other records as necessary to verify claims made to the Department under this Agreement. This section supplements but does not replace paragraph 27 of Appendix C (the Standard General Terms and Conditions, (Rev. 2/21), which are incorporated herein by reference.

Grounds for action. The Department may terminate a Provider’s Agreement and seek reimbursement from that Provider if the Department determines that the Provider, owner of the Provider, or an employee or agent of the Provider has done any of the following: 1. a. Submitted false or fraudulent claims to the CRDPABIP. 2. b. Failed to comply with any term of this Agreement. 3. c. Been precluded or excluded, either voluntarily or involuntarily, as a Medical Assistance or Medicare provider. 4. d. Been convicted of a Medicaid or Medicare related criminal offense. 5. e. Been convicted of a criminal offense under state or Federal laws relating to the services covered by this Agreement. 6. f. Been subject to license suspension or revocation following disciplinary action entered against the Provider or its health care providers providing services under this Agreement by a licensing or certifying authority. 7. g. Had a controlled drug license withdrawn or failed to report to the Department changes in the Provider’s Drug Enforcement Agency Number. 8. h. Knowingly submitted a fraudulent or erroneous patient application or assisted a patient to do so. 9. Refused i. Refusal to permit authorized state or Federal officials or their agents to examine the Provider’s medical, fiscal or other records as necessary to verify claims made to the Department under this Agreement. This section supplements but does not replace paragraph 27 of Appendix C (the Standard General Terms and Conditions, (Rev. 2/213/15), which are incorporated herein by reference.