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4.

The Provider agrees, on a continuing basis, to comply with Federal standards specified in Title XIX of the Social Security Act, and also with all applicable Federal and State laws and regulations

5.

The Provider agrees to be fully liable for the truth, accuracy, and completeness of all claims submitted electronically or on hard copy to the DepaJiment for Payment. Any submittals of false or fraudulent claims or any concealment of a material fact may be prosecuted under applicable Federal and State laws.

186.

Plaintiff Louisiana has

similar requirements

for

pharmacies

seeking to

become

eligible to receive Medicaid reimbursement for pharmaceuticals. In 1997, Louisiana enacted the

Medical Assistance Program Integrity Law (MAPIL) cited as La. Rev. Stat. AIm. §§46:437.1-

46:440.3. Louisiana pharmacies, including Omnicare dispensing pharmacies in that state, are

subject

to

MAPIL.

The

retroactive

provisions

of

MAPIL

statutorily

establish

that

(I)

the

Medicaid provider agreement is a contract between the Department and the provider, (2) the

provider voluntarily entered into that contract, and (3) providers are certifying by entering into

the provider agreement that they will comply with all federal and state laws and regulations. Id.

at §§46:437.11-46:437:14.

187.

Furthermore, to enroll as a Medicaid Provider, each pharmacy benefits provider in

Louisiana must complete a Louisiana Medicaid PE-50 Provider Enrollment Form and aPE-50

Addendum - Provider Agreement. The PE-50 Provider Agreement, drafted pursuant to MAPIL,

contains the following provisions:

  • 5.

    I agree to abide by Federal and State Medicaid laws, regulations and prograJ11 instructions that are applicable to the provider type for which I am enrolled. In understand that the payment of a claim by Medicaid is conditioned upon the claim and the underlying transaction complying with such laws, regulations and program instructions.

  • 13.

    I agree to adhere to the published regulations of the DHH Secretary and the Bureau of Health Services Financing, including, but not limited to, those rules regarding recoupment and disclosure requirements as specified in 42 CFR 455, Subpart B.

52

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