Prohibitions to Billing Enrollees Sample Clauses

Prohibitions to Billing Enrollees. The HMO and its providers and subcontractors must not xxxx a Medicaid or BadgerCare enrollee for medically necessary services covered under this Contract and provided during the enrollee’s period of HMO enrollment. The HMO and its providers and subcontractors must not xxxx a Medicaid or BadgerCare enrollee for copayments and/or premiums for medically necessary services covered under this Contract and provided during the enrollee’s period of HMO enrollment. Any provider who knowingly and willfully bills a Medicaid or BadgerCare enrollee for a Medicaid covered service shall be guilty of a felony and upon conviction shall be fined, imprisoned, or both, as defined in Section 1128B.(d)(1) [42 U.S.C. 1320a-7b] of the Social Security Act. This provision shall continue to be in effect even if the HMO becomes insolvent. However, if an enrollee agrees in advance in writing to pay for a service not covered by Medicaid or BadgerCare, then the HMO, HMO provider, or HMO subcontractor may xxxx the enrollee. The standard release form signed by the enrollee at the time of services does not relieve the HMO and its providers and subcontractors from the prohibition against billing an enrollee in the absence of a knowing assumption of liability for a non-Medicaid or BadgerCare covered service. The form or other type of acknowledgment relevant to an enrollee’s liability must specifically state the admissions, services, or procedures that are not covered by Medicaid and BadgerCare.