; (B) state that the provider will not submit any claim under this Act for any noncovered item or service provided to any individual enrolled under this Act; and (C) be filed with the Secretary no later than 10 days after the first contract to which such affidavit applies is entered into. (5) Enforcement If a provider signing an affidavit described in paragraph (4) knowingly and willfully submits a claim under this title for any item or service provided or receives any reimbursement or amount for any such item or service provided pursuant to a private contract described in paragraph (2) with respect to such affidavit— (A) any contract described in paragraph (2) shall be null and void; (B) no payment shall be made under this title for any item or service furnished by the provider during the 2-year period beginning on the date the affidavit was signed; and (C) any payment received under this title for any item or service furnished during such period shall be remitted. (6) Private contracts for ineligible individuals An institutional or individual provider with an agreement in effect under section 301 may bill or enter into a private contract with any individual ineligible for benefits under the Act for any item or service. (c) Nonparticipating providers (1) Private contracts for covered items and services for eligible individuals An institutional or individual provider with no agreement in effect under section 301 may bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act described in title II only if the contract and provider meet the requirements specified in paragraphs (2) and (3), respectively. (2) Items required to be included in contract Any contract to provide items and services described in paragraph (1) shall— (A) be in writing and signed by the individual (or authorized representative of the individual) receiving the item or service before the item or service is furnished pursuant to the contract