Grounds for action Sample Clauses
Grounds for action. The Department may terminate a Provider’s Agreement and seek reimbursement from that Provider if the Department determines that the Provider, owner of the Provider, or an employee or agent of the Provider has done any of the following:
1. Submitted false or fraudulent claims to the CRDP.
2. Failed to comply with any term of this Agreement.
3. Been precluded or excluded, either voluntarily or involuntarily, as a Medical Assistance or Medicare provider.
4. Been convicted of a Medicaid or Medicare related criminal offense.
5. Been convicted of a criminal offense under state or Federal laws relating to the services covered by this Agreement.
6. Been subject to license suspension or revocation following disciplinary action entered against the Provider or its health care providers providing services under this Agreement by a licensing or certifying authority.
7. Had a controlled drug license withdrawn or failed to report to the Department changes in the Provider’s Drug Enforcement Agency Number.
8. Knowingly submitted a fraudulent or erroneous patient application or assisted a patient to do so.
9. Refused to permit authorized state or Federal officials or their agents to examine the Provider’s medical, fiscal or other records as necessary to verify claims made to the Department under this Agreement. This section supplements but does not replace paragraph 27 of Appendix C (Standard General Terms and Conditions, Rev. 2/21).
Grounds for action. Notwithstanding the provisions of sections 4356 and 4357, the Superior Court may issue an order authorizing the superintendent to conserve, rehabilitate or liquidate a special purpose reinsurance vehicle domiciled in this State, or one or more of its protected cells, only if the superintendent proves by clear and convincing evidence or the reinsurance vehicle stipulates after notice and opportunity for hearing that:
A. There has been embezzlement, wrongful sequestration, dissipation or diversion of the assets of the reinsurance vehicle or protected cell intended to be used to pay amounts owed to the ceding insurer or the holders of special purpose reinsurance vehicle securities; or [2007, c. 386, §19 (AMD).]
B. The reinsurance vehicle or protected cell is insolvent and the holders of a majority in outstanding principal amount of each class of special purpose reinsurance vehicle securities request or consent to conservation, rehabilitation or liquidation under this subchapter. [2007, c. 386, §19 (AMD).] [ 2007, c. 386, §19 (AMD) .]
Grounds for action. The Department may terminate this Agreement and seek reimbursement from the Provider if the Department determines that the Provider, owner of the Provider, an employee or agent of the Provider, or a subcontractor of the Provider has done any of the following:
1. Submitted false or fraudulent claims to the CRDP; or
2. Failed to comply with any condition of participation in the CRDP; or
3. Failed to comply with any term of this Agreement; or
4. Been precluded or excluded, either voluntarily or involuntarily as a Medical Assistance Provider, including as a County Medical Assistance Transportation Program Provider; or
5. Been convicted of a Medicaid or Medicare related criminal offense; or
6. Been convicted of a criminal offense under state or federal laws relating to the services covered by this Agreement; or
7. Been subject to license suspension or revocation following disciplinary action by a licensing or certifying authority; or
8. Knowingly submitted to the Department a fraudulent or erroneous Patient Application for Transportation Services or assisted a patient to do so; or
9. Refuse to permit authorized state or federal officials or their agents to examine the Provider’s records as necessary to verify claims made to the Department under this Agreement. This section supplements paragraph 27 the Standard General Terms and Conditions (Rev. 2/15), which are incorporated herein by reference. The above is a non-inclusive list, which does not limit the Department's remedies for breach otherwise under this Agreement. Nor does this section prevent the Department from exercising any other right of termination the Department has under this Agreement or by law.