I1We understand that payment and satisfaction of any claims will be from Federal and State Funds and any false claims, statements or documents, or concealment of a material fact, may be prosecuted under applicable Federal and State law.
I certify that all claims provided to Louisiana Medicaid recipients will be necessary, medically needed and will be rendered by me or under my supervision.
I understand that all claims submitted to Louisiana Medicaid will be paid and satisfied from federal and state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and State Laws.
I attest that all claims submitted under the conditions of this Agreement are certified to be true, accurate and complete.
PE-50 Addendum - Provider Agreement; see also, La. Rev. Stat. Ann. §§46:437.11-46:437:14.
provider agreements with the agencies that administer Medicaid in all the other states in which it
serves as a dispensing pharmacy. The agreements typically all require the Medicaid provider to
agree that it will comply with all Medicaid regulations, including the AKS, as a condition of
Most states provide reimbursement for
Medicaid providers via an electronic or
paper-based claims process. In most states, the Medicaid claim form Omnicare submits on a
regular basis for reimbursement contains a mandatory certification that the provider has
complied with all laws and regulations pertaining to Medicaid, including the AKS.
For example, in New Jersey, the agency responsible for administering Medicaid is
between DMAHS and pharmacy service providers like Omnicare require that providers submit