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Get and Sign Oha 3973 Form 2013-2022
Services (DHHS) Centers for Medicare and
Medicaid Services (CMS), DHHS Office of Inspector General, another state, the Oregon
Health Authority (OHA), or the Oregon Department of Justice Medicaid Fraud Unit.
Payment will not be made for any services furnished by, at the medical direction of, or on
the prescription of the provider, on or after the effective date of exclusion.
Completion and submission of this form is a condition of participation under any Oregon
Health Authority’ programs or as a...
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