Fraud & Abuse. (i) No Borrower has, or to its knowledge has been threatened to have, and no officer, manager, or employee of any Borrower and, to Borrowers’ knowledge, no person with a “direct or indirect ownership interest” (as that phrase is defined in 42 C.F.R. §420.201) of 5% or more of the equity securities of Clarient, has, engaged in any of the following: (A) knowingly and willfully making or causing to be made a false statement or representation of a material fact in any application for any benefit or payment under any Healthcare Laws; (B) knowingly and willfully making or causing to be made any false statement or representation of a material fact for use in determining rights to any benefit or payment under any Healthcare Laws; (C) failing to disclose knowledge by a claimant of the occurrence of any event affecting the initial or continued right to any benefit or payment under any Healthcare Laws on its own behalf or on behalf of another, with intent to secure such benefit or payment fraudulently; (D) knowingly and willfully soliciting or receiving any remuneration (including any kickback, bribe or rebate), directly or indirectly, overtly or covertly, in cash or in kind or offering to pay such remuneration (1) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part by any Healthcare Laws, or (2) in return for purchasing, leasing or ordering or arranging for or recommending the purchasing, leasing or ordering of any good, facility, service, or item for which payment may be made in whole or in part by any Healthcare Laws; (E) presenting or causing to be presented a claim for reimbursement for services that is for an item or services that was known or should have been known to be (1) not provided as claimed, or (2) false or fraudulent; or (E) knowingly and willfully making or causing to be made or inducing or seeking to induce the making of any false statement or representation (or omitting to state a fact required to be stated therein or necessary to make the statements contained therein not misleading) of a material fact with respect to (1) a facility in order that the facility may qualify for Governmental Authority certification, or (2) information required to be provided under 42 U.S.C. § 1320a-3.
Fraud & Abuse. It is the Department's belief that the business arrangement contemplated by this Agreement is not subject to the provisions of 42 U.S.C. 1320a-7b(b) prohibiting illegal remunerations. Should the above provisions apply, it is the Department's belief that the business arrangement contemplated by this Agreement meets the discount exception found in 42 U.S.C. 1320a-7b(b)(3)(A), which excludes from prohibited activities the practice of discounting or other reductions in price obtained by a provider of services or other entity under a Federal health care program, if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under a Federal health care program. The Department currently provides CMS full and unfettered access to all information held by the Department regarding the implementation of the Illinois Medicaid Program, and shall continue to do so throughout the implementation of the State Rebate and Preferred Drug List program.
Fraud & Abuse. It is the Department’s intent that the business arrangement contemplated by this Agreement is not prohibited by the provisions of 42 U.S.C. § 1320a-7b(b), prohibiting certain illegal remuneration, as such provisions may be amended from time to time. In any event, should the provisions of 42 U.S.C. § 1320a-7b(b) apply to this arrangement, it is DMMA’s intent that the business arrangement contemplated by this Agreement meets the discount exception found in 42 U.S.C. § 1320a-7b(b)(3)(A), and regulatory safe harbor for discounts at 42 C.F.R. § 1001.952(h). The Department currently provides CMS full and unfettered access to all information held by DMMA regarding the implementation of health care delivery and reimbursement policies, and shall continue to do so for the duration of State Supplemental Rebate and Preferred Drug List programs.
Fraud & Abuse
