Prohibited Affiliations. A. The Contractor shall not knowingly have any prohibited type of relationship with the following:
1) 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. (42 C.F.R. § 438.610(a)(1).)
2) 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 this section. (42 C.F.R. § 438.610(a)(2).)
B. The Contractor shall not have a prohibited type of relationship by employing or contracting with providers or other individuals and entities excluded from participation in federal health care programs (as defined in section 1128B(f) of the Social Security Act) under either Section 1128, 1128A, 1156, or 1842(j)(2) of the Social Security Act. (42 C.F.R. §§ 438.214(d)(1), 438.610(b); 42 U.S.C. § 1320c-5.)
C. The Contractor shall not have types of relationships prohibited by this section with an excluded, debarred, or suspended individual, provider, or entity as follows:
1) A director, officer, agent, managing employee, or partner of the Contractor. (42 U.S.C. § 1320a-7(b)(8)(A)(ii); 42 C.F.R. § 438.610(c)(1).)
2) A subcontractor of the Contractor, as governed by 42 C.F.R. § 438.230. (42 C.F.R. § 438.610(c)(2).)
3) A person with beneficial ownership of 5 percent or more of the Contractor’s equity. (42 C.F.R. § 438.610(c)(3).)
4) An individual convicted of crimes described in section 1128(b)(8)(B) of the Act. (42 C.F.R. § 438.808(b)(2).)
5) A network provider or person 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 Contract. (42 C.F.R. § 438.610(c)(4).)
6) The Contractor shall not employ or contract with, directly or indirectly, such individuals or entities for the furnishing of health care, utilization review, medical social work, administrative services, management, or provision of medical services (or the establishment of policies or provision of operational support for such services). (42 C.F.R. § 438.808(b)(3).)
D. The Contractor shall provide to the Department written disclosure of any prohibited affiliation identified by the Contractor or its subcontractors. (42 C.F.R. §438.608(c...
Prohibited Affiliations. 1. The Contractor shall not:
a. Knowingly have a director, officer, or partner who is (or is affiliated with a person/entity that is) debarred, suspended, or excluded from participation in federal healthcare programs;
b. Knowingly have a person with ownership of more than five percent (5%) of the managed care entity’s (MCE’s) equity who is (or is affiliated with a person/entity that is) debarred, suspended, or excluded from participation in federal healthcare programs; or
Prohibited Affiliations. (a) The Contractor shall assure that all Affiliated Providers, including out-of-State Providers, are enrolled in the Medical Assistance Program, if such enrollment is required for such Provider by Department rules or policy in order to submit claims for reimbursement or otherwise participate in the Medical Assistance Program. The Contractor shall assure that any non-Affiliated Provider billing for services rendered in Illinois is enrolled in the Medical Assistance Program prior to paying claims.
(b) The Contractor shall not employ, subcontract with, or affiliate itself with or otherwise accept any Ineligible Person into its network.
(c) The Contractor shall screen all current and prospective employees, contractors, and sub-contractors, prior to engaging their services under this Contract by: (i) requiring them to disclose whether they are Ineligible Persons; (ii) reviewing the OIG's list of sanctioned persons (available on the World Wide Web at xxxx://xxx.xxxxx.xxx/epls) and the HHS/OIG List of Excluded Individuals/Entities (available on the World Wide Web at xxxx://xxx.xxxx.xxx/oig). The Contractor shall annually screen all current employees, contractors and sub-contractors providing services under this Contract. The Contractor shall screen out-of-State non-Affiliated Providers billing for Covered Services prior to payment and shall not pay such Providers who meet the definition of Ineligible Persons.
(d) The Contractor shall terminate its relations with any Ineligible Person immediately upon learning that such Person or Provider meets the definition of an Ineligible Person and notify the OIG of the termination.
Prohibited Affiliations. 7.1.1. The Contractor may not knowingly have a relationship of the type described in Section 7.1.2 with the following:
7.1.1.1. 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 nonprocurement activities under regulations issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549.
7.1.1.2. 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 paragraph (a)(1) of this section.
7.1.1.3. An individual or entity that is excluded from participation in any Federal health care program under Section 1128 or 1128A of the Social Security Act.
7.1.2. The relationships described in Section 7.1.1, are as follows:
7.1.2.1. A director, officer, or partner of the Contractor.
7.1.2.2. A subcontractor of the Contractor, as governed by 42 C.F.R. § 438.230.
7.1.2.3. A person 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 the Agreement. [42 C.F.R. § 438.610] 7.2. Excluded Individuals.
7.2.1. The Contractor will not use any money provided by AHCCCS under this Agreement to pay for services and/or items furnished by an individual excluded from participation in federal healthcare programs pursuant to 42 U.S.C. § 1320a-7 and/or 42 C.F.R. Parts 1001 or 1002.
7.2.2. On a monthly basis, the Contractor will determine the exclusion status of individuals and entities directly or indirectly funded through the Agreement. This directive includes individuals receiving wages for providing Agreement services. Federal guidance on how to search for the exclusion status of individuals and entities can be found at xxxxx://xxxxxxxxx.xxx.xxx/cmsgov/archived- downloads/SMDL/downloads/XXX000000.pdf.
7.2.3. The Contractor will report any discovery an excluded individual or entity to AHCCCS-OIG and AHCCCS-DFSM, and will return to AHCCCS any monies directly or indirectly paid to that individual or entity.
Prohibited Affiliations. DVHA shall not knowingly have a relationship with either of the following: • An individual who 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; and • An individual who is an affiliate, as defined in the Federal Acquisition Regulation, of a person described above. FFP is not available for amounts expended for providers excluded by Medicare, Medicaid, or CHIP, except for emergency services. For purposes of this IGA, a prohibited relationship is an employment relationship that exists between a debarred, suspended, or otherwise excluded individual, or an affiliate of such person as described above, and a commissioner, deputy commissioner or officer of the Department or a person with an employment consulting or other business arrangement with the Department.
Prohibited Affiliations. Insurer may not have a relationship with the following:
a. An individual who is debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549.
b. An individual who is an affiliate, as defined in the Federal Acquisition Regulation at 48 CFR 2.101, of a person described above.
Prohibited Affiliations. The Contractor shall not knowingly have any affiliation with prohibited individuals or entities, defined as follows:
a. 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; and
b. An individual or entity that is an affiliate, as defined in the Federal Acquisition Regulation at 48 C.F.R. § 2.101, of an individual or entity described in a., above. The above applies to the following affiliations:
a. A director, officer, or partner of the Contractor; b. A Subcontractor of the Contractor as governed by 42 C.F.R. § 438.230;
c. A person with beneficial ownership of five (5) percent or more of the Contractor’s equity;
d. A network provider or person 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 Contract; and
e. The Contractor may not have a relationship with an individual or entity that is excluded from participation in any Federal healthcare program under Section 1128 or 1128A of the Act. If the Division finds that Contractor is not in compliance with the provisions of this Section, the Division:
a. Must notify the HHS Secretary of Contractor’s non-compliance;
b. May continue this Contract with the Contractor unless the Secretary directs otherwise; or
c. May not renew or otherwise extend this Contract unless the Secretary provides to the State of Mississippi and to the United States Congress a written statement describing compelling reasons that exist for renewing or extending this Contract despite the prohibited affiliations. Nothing in this section must be construed to limit or otherwise affect other remedies available to the United States under Sections 1128, 1128A, or 1128B of the Act. Any action by the Secretary described herein is taken in consultation with the HHS Office of the Inspector General.
Prohibited Affiliations. In accordance with 42 USC §1396 u-2(d)(1), the Contractor shall not knowingly have an employment, consulting, or other agreement for the provision of items and services that are significant and material to the Contractor’s obligations under this Contract with any person, or affiliate of such person, who is excluded, under federal law or regulation, from certain procurement and non-procurement activities. Further, no such person may have beneficial ownership of more than five percent of the Contractor’s equity or be permitted to serve as a director, officer, or partner of the Contractor.
Prohibited Affiliations. Pursuant to 42 CFR 438.610, MCPs must not knowingly have a relationship with individuals debarred by Federal Agencies, as specified in Article XII of the Agreement.
Prohibited Affiliations. The Primary Contractor and its BH-MCO may not knowingly have a relationship with the following:
A. An individual or entity who 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.
B. An individual or entity who is an Affiliate, as defined in the Federal Acquisition Regulation, of a person described in paragraph (A) above.
C. An individual or entity that is excluded from participation in any Federal health care program under section 1128 or 1128A of the Social Security Act. For the purpose of this section, “relationship” means the following: • A director, officer or partner of the Primary Contractor or its BH-MCO. • A person with beneficial ownership of five percent (5%) or more of the BH-MCO’s equity. • A person with employment, consulting or other arrangement with the Primary Contractor’s or its BH-MCO’s obligations under this Agreement. I-14. interest of the Commonwealth and others No officer, member or employee of the Commonwealth and no member of the General Assembly, who exercises any functions or responsibilities under this Agreement, shall participate in any decision relating to this Agreement which affects his/her personal interest or the interest of any corporation, partnership or association in which he is, directly or indirectly, interested; nor shall any such officer, member or employee of the Commonwealth or member of its General Assembly have interest, direct or indirect, in this Agreement or the proceeds thereof. I-15. Primary Contractor Responsibilities The Primary Contractor is required to assume responsibility for all services offered in this document and Agreement whether it directly provides or contracts for the provision of the services. Further, the Department will consider the Primary Contractor to be the sole point- of-contact with regard to contract matters. Where the Primary Contractor or its BH-MCO changes ownership or undergoes a major restructuring, including any major change to the submitted organizational chart or acqui- sition of another MCO, such change must be reported to the Department 30 days prior to the change or within 48 hours of confirmation of the change. Major organizational changes may result in the Department conducting a complete On-Site Review to assess continued adh...
