Information that must be disclosed. Upon signing this Agreement and prior to renewal of the Agreement, or at any time upon written request by the Department, Provider must disclose to the Department the identity of any person who: 1.9.1.1 Has ownership or control interest in the Provider, or is an agent or managing employee of the Provider; and 1.9.1.2 Has been convicted of a criminal offense related to that person’s involvement in any program under Medicare, Medicaid, or the title XX program since the inception of those programs.
Appears in 5 contracts
Samples: Iowa Medicaid Provider Agreement, Iowa Medicaid Provider Agreement, Iowa Medicaid Provider Agreement