PIHP Ownership and Control Interests Sample Clauses

PIHP Ownership and Control Interests. In order to comply with 42 CFR 438.610, the PIHP may not have any of the following relationships with an individual who is excluded from participating in Federal health care programs: 1) Excluded individuals cannot be a director, officer, or partner of the PIHP; 2) Excluded individuals cannot have a beneficial ownership of five percent or more of the PIHP’s equity; and 3) Excluded individuals cannot have an employment, consulting, or other arrangement with the PIHP for the provision of items or services that are significant and material to the PIHP’s obligations under its contract with the State.

PIHP Ownership and Control Interests. The PIHP may not be any of the following, all of which are all specifically excluded from this contract: 1. An entity that could be excluded under section 1128(b)(8) of the Act as being controlled by a sanctioned individual. 2. An entity that has a “substantial contractual relationship” either directly or indirectly, with: a. An individual convicted of certain crimes as described in section 1128(b)(8)(B) of the Act; b. An individual or entity that is debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in non-procurement activities under regulations issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549; c. An individual or entity who is an affiliate, as defined in the Federal Acquisition Regulation at 48 CFR 2.101, of a person described in the immediately preceding subsection, 2.b.; d. An individual or entity that is excluded from participation in any Federal health care program under section 1128 or 1128A of the Act; or e. Any individual or entity that would provide those services through an individual or entity described in any of the immediately preceding four subsections, 2.b., c., or d. A “substantial contractual relationship” is any contractual relationship that provides for one or more of the following services: (i) the administration, management, or provision of medical services; and/or (ii) the establishment of policies or the provision of operational support, for the administration, management or provision of medical services. 3. An entity that employs or contracts, directly or indirectly, for the furnishing of health care, utilization review, medical social work, or administrative services, with one any individual or entity that is (or is affiliated, as defined in the Federal Acquisition Regulation at 48 CFR 2.101, of a person or entity that is): a. Debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in non- procurement activities under regulations issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549; b. Excluded from participation in any Federal health care program under section 1128 or 1128A of the Act; or c. Any individual or entity that would provide those services through an individual or entity described in any of the immediately preceding two subsections, 3....