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HomeMy WebLinkAbout05537 - AMERICAN MEDICAL RESPONSE FIELD INTERNSHIP EXPERIENCE Kathie Hart From: Judy Blumberg Sent: Tuesday, May 07, 2013 1:53 PM To: Kathie Hart Cc: John Allen Subject: American Medical Response - NCTI Contract Document#A5537 -this will not be renewed. 094OB&M69%d¢"&W tatzM 04""tant d6hn 8p"-i OFLtaOapatbnant 300 dK 06&&01tvad L-Pahn epthW eof 92262 (760)JEM787 AFFILIATION AGREEMENT FOR FIELD INTERNSHIP EXPERIENCE TMS AFFILIATION AGRF,FMFNT FOR FIELD malriculalion, promotion and graduation and shall be iNTERNSFIIP EXPERIENCE is made between American approved or accredited by relevant licensing/cenifying Medical Response West, d/b/a Northern California Training agencies in the state(s) and county(ies) in which Institute,("School")and the Contractor(the"Contractor')set out School resides and in which the program contemplated on The signature page of this Agreement herein is to operate. WHEREAS, School is a program which osiers a program of 2.2. Approval by Licensing/Certifying Agency(ic%). instruction leading to certification or licnnsure of its students as School shall secure from all relevant Zinorgeney Medical Technician,Emergency Medical Technician- liccnying/ecrtifying agencies written approval for the Paramedic and other, similar health care and prc-hospital Field Internship Experience program contemplated providers("Students"), herein and shall maintain such approval throughout the course of The program. School shall provide WHEREAS, As a part of the licensing and/or certification Contractor with a copy of the written approval and requirements Students must complete a courbc of study including — applicable guidelines or protocols applicable to the a field intcmbhip experience ("Field Internship Experience') by program before asmgnfng a Student to the Field and through assignment to various mobile intensive care units Internship Experience program. operated by Contractor; 2.3. StudenT Lieensnre/CerNScatian. School shall WHEREAS, Contractor is a provider of emergency medical ensure that each Student enrolled in the clinical service, including both advanced life support and basic life program is compliant with any hcensure certification support prc-hospital care and transport, and Contractor has required for participation in this program,which may agreed to assist School by providing a limited Field internship include, but is not limited to state EMT and CPR Experience for Students, upon certain terms and conditions, so credentials or any provisional liccnsure/ccr(ificativn, long as its participation in the progranh does not jeopardize School shall providc Contractor with a copy of the patient care or compromise Contractor's standards of service to requisite liccnsure and or curiication for any Student its patients enrolling in the Field Intemyhip Experience before the Student is allowed to participate in the program NOW THEREFORE, in consideration of the foregoing and for unless,the licensing/certifying agencies advise Schaal other good and valuable consideration, the receipt and sufficiency and Contractor, in writing,that licensure/certification of which arc hereby acknowledged, the parties hereto agree as is not required and the Field Internship Experience follows: program is approved under all applicable, or potentially applicable,laws and mgulationb. 1. TERM. 2.4. Approval by Doctor or Agency Having Medical 1.1, Commencement Date. This agreement shall become Control. If applicable, School will secure from the effective when signed by all of the parties("Effective doctor or agency having medical control in the statc(s) Dare") and completion of the written approval and or county(ics) in which program will operate, written certification contemplated in paragraph 2.2, 2.3 and approval for the Field Internship Experience. Such 2.4. This agreement shall be for a term of twenty-four written approval shall,at a minimum,define the scope (24) months from the Effective Date. Any renewal of practice and required supervision of any Studcnt shall be set fords in a writing signed by the panics School will in the course of clinical pducatw e School will provide Contractor with a copy of The 1.2. Termination, This agreement may be terminated by approval contemplated in this paragraph before either party, with or without cause, upon thirty (30) assigning any Strident to the clinical program. days written notice to the other party ab provided 2,-5. Records. School will keep and maintain accurate herein. records for all Students participating in the Field 2. RIGHTS AND OBLIGATIONS OF SCHOOL Internship Experience. The records will include the Students transcript, liccnsure or certification. 2.1. School's Accreditation School shall mainlain a temporary license or certification (if applicable), pre" qualified educational program for Studcntb designed to a4scbsmenl health record, and record of history / providc a smooth transition into liccnsure/certitication vaccination / immunization as set Forth in paragraph of Students as Emergency Medical Technicians, 2.8 hereof. School will maintain tile records For a Emergency Medical Technician-Paramedics or oiler period of at least four(4)years (or any greater period similar pre-hospital health cart providers. School'b as may be required by applicable) from the date program shall include programming, administration, Student completes, or ceases to participate in, The equipment must be in the possession of the Student as Field Internship Experience contemplated herein. a condition of their participation in the program. Failure to possess and use The required OSHA 2.6- List of Participants, Qualifications, Objectives and equipment will result in Student's dismissal from the Representations. School will notify Contractor at program. least thirty(30)days prior to the inception of a course of Field Intcroship Experience of the names, 2.11. Assistance in Obtaining Signatures and qualifications and performance objectives for each Compliance, School recognizes that its Stndcnts have Student scheduled to begin their Field intemship certain obligations and will be required to execute Experience. inclusion by School of a Student's name certain documentation in order to be eligible to on this list is School's representation that the Student participate in the program. School shall assist possesses the necessary skills, llccnsure/certification Contractor in obtaining any necessary signatures and and immunizations to engage in the Field Internslhip ensuring Studer compliance with Contractor rules Experience. The School shall comply wish any and this agreement including, but not limited to.Those requirements or procedures Thai Contractor requires contained in part 3 of this agreement. regarding documentation To verify the Student's qualifications for the Field Internship Experience 2.12. Evaluation of Performance. School, in conjunction with Contractor personnel, is responsible for and shall 2.7. Contractor Rulcs and Regulations School will use make arrangements for evaluating Student's all reasonable efforts to cause Students to comply with performance during the clinical program. Contractor's policies, procedures. work rules and rcgulations, including prescrvahon of the 2.13. Minimum Age of Participants. School and confidentiality of-patient care and patient care records. Contractor will only allow Students that are at least School will, prior to allowing a Student to participate eighteen (18) years of age to participate in this in the Field Internship Experience, review patient program. inclusion of a Student's name on the list confidentiality as well as the Contractor's policies, referenced in paragraph 2.6 is School's representation procedures, work rules and regulations with Student thar Student is at least eighteen(18)years of age. and secure Student's agrccmcm to abide by all such rules and rcgulaliont. 3- STUDENT OBLIGATIONS AND REQUIREMENTS. 2.8. Pre-assignment Health Assessment. School will 3.1. Release. Student will, prior to participating in the cause Student to complete a pre-assrgmnem health clinical experience, read, understand and sign a ride- assessment, at Student's or School's expense, which along waiver releasing Contractor from any and all includes, but is not limilcd lo- history of liability and/or responsibility arising out of Student's communicable diseases and immunival'ionS, proof of participation in the Clinical Experience. This release tetanus vaccination or immunization, proof of of claims must be executed, and on file with the Hepatitis B vaccination or executed declination and School, prior to Student participation in the program. waivers of The Hepatitis B vaccination by the Student, The release is a condition prcccdcnt to Student's proof of MMR vaccination,respirmory certification by participation in the clinical experience and no Student a physician and PPD test. School will provide proof will be permitted on a Convactor vehicle without of satisfactory complctron/vaccination to Contractor having signed The release. the release is anached upon request.Inclusion of a Student's name on the list hereto and made a part hereof as Exhibn A. referenced in paragraph 2.6 is School's representation that Student has completed the pre-ass'ignmcnt 3.2. Pvc-assignment Health Assessment. Snider shall assessment and Is physically able to perform the tasks complete a pre-assignment health assessment as set associated with the program. forth in paragraph 2.8 hereof. 2.9. OSHA Compliance Prior To allowing Snrdent to 3.3. Contractor Rules and Patient Confidentiality. cmoll in the course of Field Internship Experience, Student shall comply with Contractor's procedures, School will educate and train Studer in compliance policies, rules and regulations, including maintenance with all relevant and required OSHA rcgulations of patient and records confidentiality Students, while including, but not limited to. Blood-home Pathogens participating in the clinical program, on Contractor Standard and TJ3 Standard property, must meet all standards of appearance and conduct required by Contractor of its own employees. 2.10- Personal Protective Equipment, School shall Student shall comply with all applicable OSHA rules provide Student with all necessary personal protective or regulations. Student shall have in their possession equipment,including fining,as is,or may be,required at all times when on board a Contractor vehicle by OSHA or other regulatory agency as required in personal protective equipment and use such equipment locale of Contractor prior to assignment to the Field when, as and where designated by Convactor Internship Experience. Such equipment may include personnel, Any information generated as a result of safety glasses, face shields and pariculare respirators. the activities set forth in this agreement, including School recognizes and will inform Student Thar this information regarding patients or business activities of 2 4.6. Student Evaluations. Contractor will cooperate with School to performing evaluations of Student's Field Internship Experience. 4.7. Provision of Field Internship Experience. Contractor will provide a Field Internship Experience for the School's Students in compliance with the guidelineY, protocols. scope of practice provided by the hcensmg/ccrti tying agency and in accord with the 3.4. Student Intern Agreement. Student will read and Instructions of the doctor or agency having medical execute the student intern agreement, Execution of control, if applicable. The number of Students that the student intern agreement is a condition precedent Contractor accepts into the Field Internship to participation in the Field Internship Experience Experience shall be determined by mutual agmcmcnt program. The student intern agreement is attached between School and Contractor. hereto and made a part hereof as Exhibit A. 5. iNDEMNTFICATION 4. CONTRACTOR RIGHTS AND OBLIGATIONS. 5.1. Indemnity for Third Party Claims. School will 4.1. Contractor Rules. Contractor requires Students, save,defend,indemnify and hold hamtcss Contracor, while participating in the clinical program, on its officers, employees, agents, affiliates and Contractor property, to meet all standards of representatives of and from any and all claims, Suits, appearance and conduct required by Contractor of its costa and actions arising out of the provision of the own employees Contractor reserves the right to Field Internship Experience. This indemnity shall refuse to allow any Student to participate in the survive and remain enfomwbic after the expiration or clinical program for failure to comply with Contractor termination of this Affiliation Agreement, provided standards. however, that this indemnity is not intended to cover claims against Contractor wibino solely out of 4.2_ Student's Skill Level. Contractor reserves the right Contractor's own negligence or intentional conduct, to discontinue Student's participation in the program should Contractor,m its sole discretion,determine that 5.2. indemnity for Student Claims. School will save, Student's skill level is substandard Contractor will defend, indemnify and hold harmless Contractor, its immediately advise School of any such concerns or officers, employees, agents, affiliates and situations. representatives of and from any and all clanns, suits, costs and actions brought by any Student, or their 4.3- Orientation Program. Contractor may require heirs, against company arising out of their Student to attend an orientation program designed to participation in this program or by any patient orient Student to Contractor's rules regulations and claiming that the negligence of Student caused, policies prior to beginning their Field Internship compounded or exacerbated their injuries. This Experience. The details and procedures for the indemnity shall survive and remain enforceable after orientation program bhall be in the Contractor's sole the expiration or termination of this Affiliation discretion. Agreement; provided, however, that this indemnity is not intended to cover claims against Contractor wising 4.4. Contractor's Control of Patient Care. Contractor solely out of Contractor's own nugligcncc or reserves the right to determine where, when and if a intentional conduct. Student may participate in the provision of care to its patients. Contractor will endeavor to utilize Student. 5.3. Defense Obligation. In any action in which Schaal is and allow them to utilize as many of their skills in as obligated to provide Contractor with a defense,School many situations as possible. However, patient care is shall at its cost and expense, fully and diligently paramount and Student shall follow Contractor's defend Contractor against any claims brought, instructions with respect to the provision of patient investigations undertaken or actions Fled which care concern claims for which Contractor is entitled to indemnification under paragraphs 5.1,5.2,and 5.3. 4-5, Right to Control Participation. Company reserves the right to refuse to allow any Student to participate 6. INSURANCE. in the provision of care at the scene of wi emergency where, in company's sole discretion, permitting 6-1. Professional Medical Liability and General Student to participate would endanger the Student, a Liability Coverage School will maintain paricnt or an employee of Company or otherwise be Professional Medical Liability and General Liability inappropriate. coverage of not less than one million dollars (51,000,000.00) per occurrence and three million dollars (53.000,000.00) aggregate. Coverage must ,specifically cover Students in the Field Internship 3 Expuricncc, working under This agreement and within verifcation of receipt Notice shall be sent to the the course of their training and education during Chit following addresses: program, School will name Contractor as an Additional insured under the policy and include an Ifto Contractor: indemnification provision, by endorsement, to be atrached to the certificate of insurance School will Palm Sprinp4 Firc Department provide Contractor with written verification of 300 N.Cielu Road coverage In the form of a ourtificatc of insurance, fain Springs,CA 92262 which will be attaehud to this agreement. School covenants to keep the required insurance in force and lfto School: effect through the term of this agreement and maintain tail coverage for five (5) year$ thereafter if the American Medical Response West. coverage was a"clams made"policy. dPo/a Northern California Training institute 333 Sunrise Avenue,Suite 500 6.2. Endorsement for Student Activities. School assures Roseville.California 95661 Contractor that all coverage of insurance required herein includes specific provisions and/or With Mandatory Copy to: endorsements to include Students within School's Medical Liability and General Liability coverage for Legal Dopartmcnt all activities conducted under this program. American Medical Response,Inc 6200 South Syracuse Way,Suite 200 6-3- Coverage for Student Injuries. School recognizes Greenwood Village,Colorado Ul I I thal Students arc N0f covered by Contractor's Workers Compensation Insurance or Self Insured S. Fees,Compensation and Tuition Program. School represents and warrants that it will maintain, or ensure that its Students arc covered, Far 8.1. pees, Compensation and Tuition. If applieablc, any bodily injury and disease should any Student be fees, compensation and tuition thin Contractor shall injured or became ill dining the course of then-Field receive will beset forth in Exhibit h3. Internship Experience. School will provide Contractor with a written verification of insurance coverage in the form of a certificate of insurance which will be 9• Scope of field internship Experience attached to this agreemenl, 9A, Scope of Field internship Experience. The specife 6.4. Amount of Coverage Not a Limitation. The amount scope of the Field Internship Experience that the of insurance required hereunder shall not limit Contractor shall provide will be sit forth in Exhibit C. School's liability nor relieve School of any obligation hereunder. 10. MISCELLANEOUS. 6.5. Minimum Qualifications of Insurer. Any policies of 10-1. Miscellaneous. This Agreement (including the insurance shall be maintained with insurance Schedules and Exhibits hereto): (a) constitutes the companies: (i) holding a "General Policyholder's entire agreement between the parties with respect to Rating" of AIV or better, as set forth in the mosr the subject matter hereof,superseding all prior oral or currcm issue of "Best's Tnwrancc Guide," on written agreements with respect thereto; (b) may be comparable rating from reputable rating organizations, amended only by written instrumenr executed by both (ii)licensed to operate and sell insurance in the state in parties. (c) may not be assigned by either party which the Field Internship Experience will occur; and without the written consent of the other party, such (ui)in good standing and admitted,if applicable,with eun$ent not to be unreasonably withheld; (d) shall be the states Department of Insurance or other similar binding on and more to the benefit of the parties regulatory agency in the stare in which the Field hereto and their respective successors and permitted Internship Rxpericncc will occur assigns; (c) shall be interpreted and enforced In accordance with the laws of the State of the principal 7. NOTICES. ellToe of the SCIrIOI, without regard to the conflict of laws provisions thereof, and the Federal laws of the 7.1. Any notice required of permitted by this Agreemcnt Unnred Stares applicable therein; (f) this Agreement shall be in writing and shall be delivered as follows, may be executed in several counlerparts(including by with notice deemed given as indicated:(a)by personal facsimile), each of which shall constitute an original delivery, when delivered personally; (b)by overnight and all of which,when taken together, shall constitute courier, upon written verification of receipt; (c)by one agreement; and (g) this Agreement shall not be facsimile transmission, upon acknowledgment of effective until executed by both panes.In the event of receipt ofclactromc transmission,or(d)by certified or a dnsagrecmenr between this Agreement and any registered mail, return rcccipt requested, upon Schedule hereto, the terms of this Agreement shall govern, 4 11. Other. 11.1. Compliance with Laws. The parties will comply in all material respects with all applicablc fcdcral and state laws and regulations including, the federal Anti- kickback stature. 11.2. Compliance Program and Code of Conduct. The Contractor acknowledges That School has made available to School a copy of its Compliance Program and Code Of Conduct at School's web site. located at: www.amr.net. The School shall comply with any training requirements that may be legally imposed upon School by any applicable regulatory authority. 11.3. Non-Exclusion. Each party represents mid certifies that it has not been convicted of airy conduct identified on Exhibit D Each party further represents mid certifies that it is not ineligible to participam in Federal health care programs or in any other stale or federal government payment program, us provided on Exhibit D or otherwise. Each party undcrslands that if DHHS or OIG excludes it, of any of its employees who provide health cue services,fiom participation in Federal health care programs,the party must notify the other party within 5 days Of knowlcdgc of such fact, and the other parry may immediately turminato the Agreement. IN WITNESS WHEREOF,the pones have hereto executed this Agrccmcnt. AMERICAN MEDICAL RESFONSf WES1, d/b/a NORTHERN CALIFORNIA TRAINING INSTITU 11 2007.06.20 By 15-1331 —07'00' Lawson Smart,RN,MBA,MIC13 Executive Director,Academic Programs Date: APPROVED BY CITY MANAGER P'AG.NP SPC21NG5 LrvrzE tlDEN,\oi'ONtlG;�A By. rr LL APPROVED AS TO FORM! Print Print Title: fi�e L'k'e'F' Date: 7/9�07 We: A EST- vGity Manager ty Clerk 5 Exhibit A Student Intern Agreement and Release Student is enrolled in a course of study at Experience program. School designed to enable Student to become a licensed/certnficd Emergency Medical Technician, The School shall require its students to complete a Criminal Emergency Medical Technician-Paramedic or other similar Offenders Record information ("CORI") check By virtue pic-Contractor health care provider. As part of the of this agreement, the School assures Contractor that it curriculum, Student has enrolled in the Field Internship found no information that would, in accordance with the Experience, which is offered through the School, with provisions of state EMS regulations, preclude the Student Contractor's assistance. The field internship Experience from the duties of an EMS provider. involves 1) Student's performing acquired pre-liospital skills alongside Contractor's personnel, and, 2) "17le relationship of field internship Student and Contractor accompanying and observing to Contractor's personnel is that of a student being provided an educational providing emergency and non-emergency ambulance experience by Contractor and such activity shall in no way transport,care and related services., be construed as creating any other relationship including an employment relationship. The Student shall receive no Student has asked to participate in Field Internship compensation from Contractor for activities during the Experience Imowng that participation will require Student internship. to accompany Contractor personnel in dangerous and potentially lift-LhrcatcnSng situations. Student realizes that l Ile Student will comply in all material respects with all Contractor could not, and would not, allow Student to applicable federal and state laws and regulations including, accompany its personnel without his/her agreement to: (i) the Federal Aral-kickback statute. The Student release the Contractor from anv and all claims for injury or acknowledges that School has made available to Student a death which may result from Student's participation in the copy of its Compliance Program and Code of Conduct at program; (it) assume the risk of dearh or injury associated School's web site, located of www amr.ncT. The Smdent with the Field Internship Experience; (hi) agree to read, shall comply with any training requirements that may be understand and follow Contractor's policies, procedures legally imposed upon School by any applicable regulatory and guidelines; (iv) act in a professional and respectable authority. manner at all limes;and(v) follow the instruction/direction of Contractor personnel with respect to patient care, The Student represents and certifies that he/she has not demeanor.safety,use of personal protective devices,etc. been convicted of any conduct identified on Attachment "A The Student further represents and certifies That he/she Student understands that he or she is exposing himself or is not ineligible to participate in Federal health cue herself to certain risks inherent in the activities associated programs or in any other stale or federal government with the Field internship Experience. Student hereby payment program, as provided on Attachment "A" or represents that he or she AQRF.FS TO ASSUME TTW otherwise. The Student understands that if DHHS or OIG RISKS 1NHMZJI NT IN THE ACTIVITY. These risks excludes he/she from participation in Fcderal health care include, but are not limited to, being hurt or injured. (1)by programs, he/she must notify the School and Contractor broken glass(or other scene hazards)including various cuts within 5 days ofk nowledge of such fact,and the Contractor about the head, face. eyes, hands, legs, mid torso, (2) by may immediately terminate the Agreement. uxposurc to tetanus or contagious diseases such as the Hepatitis B virus and the Human Immunodeficiency Virus Sludcnt tali Fics that he/she is at (cast eighteen (18) years C FIN"); (3) injury due to gurney lifts and or drops; (4) old and is an adult with full legal authority to execute This injury from slip and fall type incidents; (5)various strains release. and/or sprains to one and/or all muscle groups; (6) 6As associated with emergency vehicle operation;and(7)risks B y ,Signing this Document You Acknowledge That You at the scene of cmergcneles including assault and battery. Have Been Advised That There Are Risks Inherent in this 21 pe of Activity and Have Decided to Assume That Risk In consideration of Contractor's agreement to provide the and Release tie Company of and from All Liability. You Field Internship Experience to Student, Student agree to Agree ta, Release the Company from Any Claims release and forever discharge Contractor and its agents, Associated with the Event and That You, Not t1le employees affiliates, parent corporation, successors and Company, Are Assuming Complete and Total assigns of and from all claims, demands, suits, injuries or Responsibility for and Any and All Injuries, Damages or damages of any hind arising in any way out of the Leases That You May Suffer as a Result of Participarfng participation in this program in the Field Internship Experience Program. Student Further agrees to: (i) follow Contractor's policies, procedures and work rules; (in) follow Contractor's instrucrion and direction with respect to pabcnt care,safety, personal protection; and, abide by Contractor rules and direction Student understands That failure to follow the Contractor's direction may result, in Contractor's sole discretion, in his/her expulsion Front the Field Internship 6 I agree to all terms set forth above. (3) Felony conviction relating to health care fraud. Any individual or entity that has been convicted for an olemo which occurred after August 21, Dated: 1996, under Federal of State law, in connection with the delivery of a health care item or service or with respect to any act or omission in a health care program (other than Signature of Student: those specifically described in paragraph (1)) operated by or financed in whole or in purl by any Federal, State, or local government agency, of a criminal offense consisting Print Name: of a felony relating to fraud,theft embezzlement,breach of fiduciary responsibility,m other financial misconduct. Attachment"A" (4) Felony conviction relating to controlled Overview of law regarding exclusion from substance. Any individual or entity that has been convicted for an of"fensc which occurred after August 21, 1996,under Medicare and State Health Care.Programs Federal or State law, of a criminal offence consisting of a 42 U.S.C. 1320a-7 folony relating to the unlawful manufacture, distribution, prescription,or dispensing of a controlled substance. (a) Mandatory exclusion. The Secretary shall exclude the following individuals and entities From participation in any Federal health care program(as delined (b) Permissive exclusion. The Secretary may in section 1320a-7b(f)of this title): exclude individuals and entities from participation in any Federal health care program. These Permissive Pxclusions (1) Conviction of program-mlatcd crimes are for misdemeanors of the above (see 42 USC 1320a- Any individual or entity that has been convicted of a 7(b)(1.15)) offenses plug other infractions that shall be criminal offense related to the delivery of an item or survicc determined on an individual cuss-by-cast basis under subchapter XVIII of this chapter or under any State health care program. (NOTE: the DII}IS and OIG list of excluded 2 Conviction relating to individuals/entities is available through the Internet at O patient abuse. http://ww bb3 gov/oig), and an overview of the Any individual or entity that has been wnvicted, under redcral or State law, of a criminal ollenbe relating to exclusion regulations is attached hereto). neglect or abuse of patients in connection with the delivery of a health care item or service 7 Exhibit S Fees, Compensation and Tuition Neither party to this agreement shall receive any fees,compensation,or coition from the other parry for the provision of any services parsaam to the terms hereof. Exhibit C Scope of Field Internship Experience The Field Internship shall be conducted in accordance with the terms and requirements as mutually agreed to by the parties. 9 Exhibit D Overview of law regarding exclusion from Medicare and State Health Care Programs 42 U.S.C. 1320a-7 (a) Mandatory exclusion. The Sccrctary shall exclude the following individuals and entities from participation in any Federal health care program(as defined in section 1320a-7b(t)of this title): (1) Conviction of program-related crimcs Any individual or entdv that has been convicted of a criminal offense related to the delivery of an item or service under subchapter XVIII of this chapter or under any State health care program. (2) Conviction relating to patient abuse. Any individual or cnuty that has been convicted,undur Federal or State law,of a criminal offense rclating to neglect or abuse of-patients in connection with the delivery of a health care item or bcrvicc. (3) Fclony conviction relating to health care fraud. Any individual or cmity that has been convicted for an offense which occurred aller August 21, 1996.under Federal or State law,in connection with the delivery of a health care item or service or with respect to any act or omission in a health care progrann(other than those specifically described in paragraph(1)) operated by or financed in whole or in part by any Federal.Stare,or local government agency,of a criminal offense consisting of a Felony relating to fraud,theft,embezzlement,breach of fiduciary responsibility.or other financial misconduct, (4) Felony conviction rclating to controlled substance. Any individual or cntiry that has been convicted for an offense which occurred after August 21, 1996, under Fcdcral or State law,of a ctuninal offence consisting of a felony relating to the unlawfid mmnufactute,distribution,prescription,or dispensing of a controlled substance. (b) Permissive exclusion. The Secretary may exclude individuals and untitics from participation in any Federal health care program. These Pennisbivu Exclusions an; for misdemeanors of the above (sue 42 USC 1320a-7(b)(1.15)) offenses pIw other infractions that shall be deatni inud on an individual case-by-case basis. (NOTE: the DITIIS and OTC list of excluded individuals/entities is available through the Internet at http://www.hhs.�ov/aig),and an overview of the exclusion regulations is attached hereto). 10