Common use of Restriction, Suspension or Termination of Participating Providers Clause in Contracts

Restriction, Suspension or Termination of Participating Providers. Medical Group shall, as warranted, immediately restrict, suspend or terminate its Participating Providers from providing or arranging Covered Services to Medical Group Members in the following circumstances: (i) the Participating Provider ceases to meet the licensing/certification requirements or other professional standards described in this Agreement; (ii) PacifiCare or Medical Group reasonably determines that there are serious deficiencies in the professional competence, conduct or quality of care of the Participating Provider which affects or could adversely affect the health or safety of Medical Group Members; or (iii) the Participating Provider files an affidavit with the Medicare Program promising to furnish Medicare-covered services to Medicare beneficiaries only through private contracts under Section 1802 (b) of the Social Security Act. Medical Group shall immediately notify PacifiCare of any of its Participating Providers who cease to meet the licensing/certification requirements or other professional standards described in this Agreement and Medical Group’s actions under this Section. If Medical Group fails to act as required by this Section with respect to any of its Participating Providers, PacifiCare shall have the right to immediately prohibit such Participating Providers from continuing to provide Covered Services to Medical Group Members.

Restriction, Suspension or Termination of Participating Providers. Medical Group shall, as warranted, immediately restrict, suspend or terminate its Participating Providers from providing or arranging Covered Services to Medical Group Members in the following circumstances: (i) the Participating Provider ceases to meet the licensing/certification requirements or other professional standards described in this Agreement; (ii) PacifiCare or Medical Group reasonably determines that there are serious deficiencies in the professional competence, conduct or quality of care of the Participating Provider which affects or could adversely affect the health or safety of Medical Group Members; or (iii) PacifiCare reasonably demands that the Participating Provider files an affidavit with the Medicare Program promising to furnish Medicare-covered services to Medicare beneficiaries only through private contracts under Section 1802 (b) of the Social Security Actbe restricted, suspended or terminated. Medical Group shall immediately notify PacifiCare of any of its Participating Providers who cease to meet the licensing/certification requirements or other professional standards described in this Agreement and Medical Group’s actions under this Section. If Medical Group fails to act as required by this Section with respect to any of its Participating Providers, PacifiCare shall have the right to immediately prohibit such Participating Providers from continuing to provide Covered Services to Medical Group Members.