(A) The department of medicaid shall coordinate with the attorney general to create a disclaimer form that provides an affirmative and explicit explanation of the penalties specified in section 2913.40 of the Revised Code for medicaid fraud.
(B) The department shall provide a copy of the disclaimer form to each person or government entity seeking to participate in the medicaid program as a provider. The department shall not enter into a provider agreement with a person or government entity until the person or government entity has signed and returned the disclaimer form to the department, acknowledging that the person or government entity has received and reviewed the form.