Common use of PIHP Responsibilities for Monitoring Ownership and Control Interests Within Their Provider Networks Clause in Contracts

PIHP Responsibilities for Monitoring Ownership and Control Interests Within Their Provider Networks. At the time of provider enrollment or re-enrollment in the PIHP’s provider network, the PIHP must search the Office of Inspector General’s (OIG) exclusions database to ensure that the provider entity, and any individuals with ownership or control interests in the provider entity (direct or indirect ownership of five percent or more or a managing employee), have not been excluded from participating in federal health care programs. Because these search activities must include determining whether any individuals with ownership or control interests in the provider entity appear on the OIG’s exclusions database, the PIHP must mandate provider entity disclosure of ownership and control information at the time of provider enrollment, re-enrollment, or whenever a change in provider entity ownership or control takes place. The PIHP must search the OIG exclusions database monthly to capture exclusions and reinstatements that have occurred since the last search, or at any time providers submit new disclosure information. The PIHP must notify the Division of Program Development, Consultation and Contracts, Mental Health and Substance Abuse Administration in MDCH immediately if search results indicate that any of their network’s provider entities, or individuals or entities with ownership or control interests in a provider entity are on the OIG exclusions database.

PIHP Responsibilities for Monitoring Ownership and Control Interests Within Their Provider Networks. At the time of provider enrollment or re-enrollment in the PIHP’s provider network, the PIHP must search the Office of Inspector General’s (OIG) exclusions database to ensure that the provider entity, and any individuals with ownership or control interests in the provider entity (direct or indirect ownership of five percent or more or a managing employee), have not been excluded from participating in federal health care programs. Because these search activities must include determining whether any individuals with ownership or control interests in the provider entity appear on the OIG’s exclusions database, the PIHP must mandate provider entity disclosure of ownership and control information at the time of provider enrollment, re-enrollment, or whenever a change in provider entity ownership or control takes place. The PIHP must search the OIG exclusions database monthly to capture exclusions and reinstatements that have occurred since the last search, or at any time providers submit new disclosure information. The PIHP must notify the Division of Program Development, Consultation and Contracts, Mental Behavioral Health and Substance Abuse Developmental Disabilities Administration in MDCH immediately if search results indicate that any of their network’s provider entities, or individuals or entities with ownership or control interests in a provider entity are on the OIG exclusions database.