Common use of Fraud and Abuse Matters Clause in Contracts

Fraud and Abuse Matters. Neither the Company nor any Company Subsidiary, nor the officers, directors, employees or agents of any of the Company or any Company Subsidiary, have engaged in any activities which are prohibited, or are cause for civil penalties or mandatory or permissive exclusion from Medicare, Medicaid, or any other State Health Care Program or Federal Health Care Program under Sections 1320a-7, 1320a-7a, 1320a-7b, or 1395nn of Title 42 of the United States Code, the federal CHAMPUS statute, or the regulations promulgated pursuant to such statutes or regulations or related state or local statutes or which are prohibited by any private accrediting organization from which the Company or any Company Subsidiary seeks accreditation or by generally recognized professional standards of care or conduct, including but not limited to the following activities: (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; (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; (c) presenting or causing to be presented a claim for reimbursement under CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program that is (i) for an item or service that the person presenting or causing to be presented knows or should know was not provided as claimed, or (ii) for an item or service and the person presenting knows or should know that the claim is false or fraudulent; (d) knowingly and willfully offering, paying, soliciting or receiving any remuneration (including any kickback, bribe, or rebate), directly or indirectly, overtly or covertly, in cash or in kind (i) in return for referring, or to induce the referral of, 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 CHAMPUS, Medicare, Medicaid, or any other State Health Care Program or Federal Health Care Program, or (iii) in return for, or to induce, the purchase, lease, or order, or the arranging for or recommending of the purchase, lease, or order, of any good, facility, service, or item for which payment may be made in whole or in part by CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program; 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 material fact required to be stated therein or necessary to make the statements contained therein not misleading) or a material fact with respect to (i) the conditions or operations of a facility in order that the facility may qualify for CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program certification, or (ii) information required to be provided under SSA Section 1124A.

Fraud and Abuse Matters. Neither the Company Acquiror nor any Company Acquiror Subsidiary, nor the officers, directors, employees or agents of any of the Company Acquiror or any Company Acquiror Subsidiary, have engaged in any activities which are prohibited, or are cause for civil penalties or mandatory or permissive exclusion from Medicare, Medicaid, or any other State Health Care Program (as defined in Section 1128(h) of the federal Social Security Act ("SSA")) or Federal Health Care Program (as defined in Section 1128B(f) of the SSA) under Sections 1320a-7, 1320a-7a, 1320a-7b, or 1395nn of Title 42 of the United States Code, the federal CHAMPUS statute, or the regulations promulgated pursuant to such statutes or regulations or related state or local statutes or which are prohibited by any private accrediting organization from which the Company Acquiror or any Company Acquiror Subsidiary seeks accreditation or by generally recognized professional standards of care or conduct, including but not limited to the following activities: (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; (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; (c) presenting or causing to be presented a claim for reimbursement under CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program that is (i) for an item or service that the person presenting or causing to be presented knows or should know was not provided as claimed, or (ii) for an item or service and the person presenting knows or should know that the claim is false or fraudulent; (d) knowingly and willfully offering, paying, soliciting or receiving any remuneration (including any kickback, bribe, or rebate), directly or indirectly, overtly or covertly, in cash or in kind (i) in return for referring, or to induce the referral of, 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 CHAMPUS, Medicare, Medicaid, or any other State Health Care Program or Federal Health Care Program, or (iiiii) in return for, or to induce, the purchase, lease, or order, or the arranging for or recommending of the purchase, lease, or order, of any good, facility, service, or item for which payment may be made in whole or in part by CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program; 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 material fact required to be stated therein or necessary to make the statements contained therein not misleading) or a material fact with respect to (i) the conditions or operations of a facility in order that the facility may qualify for CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program certification, or (ii) information required to be provided under SSA Section 1124A.

Fraud and Abuse Matters. Neither the Company nor any Company Subsidiary, nor the officers, directors, employees or agents of any of the Company or any Company Subsidiary, have engaged in any activities which are prohibited, or are cause for criminal or civil penalties or mandatory or permissive exclusion from Medicare, Medicaid, Medicaid or any other State Health Care Program or Federal Health Care Program Program, under Sections ss.ss. 1320a-7, 1320a-7a, 1320a-7b, or 1395nn of Title 42 of the United States Unixxx Xtates Code, the federal CHAMPUS Federal Employees Health Benefits program statute, or the regulations promulgated pursuant to such statutes or regulations or related state or local statutes or which are prohibited by any private accrediting organization from which the Company or any Company Subsidiary its Subsidiaries seeks accreditation or by generally recognized professional standards of care or conduct, including but not limited to the following activities: (ai) 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; (bii) 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; (ciii) presenting or causing to be presented a claim for reimbursement under CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program that is (i) for an item or service that the person presenting or causing to be presented knows or should know was not provided as claimed, or (ii) for an item or service and the person presenting knows or should know that the claim is false or fraudulent; (div) knowingly and willfully offering, paying, soliciting or receiving any remuneration (including any kickback, bribe, or rebate), directly or indirectly, overtly or covertly, in cash or in kind (i) in return for referring, or to induce the referral of, 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 CHAMPUS, Medicare, Medicaid, or any other State Health Care Program or Federal Health Care Program, or (iii) in return for, or to induce, the purchase, lease, or order, or the arranging for or recommending of the purchase, lease, or order, of any good, facility, service, or item for which payment may be made in whole or in part by CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program; or (ev) 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 material fact required to be stated therein or necessary to make the statements contained therein not misleading) or a material fact with respect to (i) the conditions or operations of a facility in order that the facility may qualify for CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program certification, or (ii) information required to be provided under SSA Section ss. 1124A.

Fraud and Abuse Matters. Neither Except as set forth in Section 4.9 of the Company Sellers’ Disclosure Schedule, none of the Sellers, nor any Company Subsidiary, nor of the officers, directorsemployees, employees or or, to the Seller Parties’ Knowledge, agents of any the Sellers, and none of the Company or any Company Subsidiary, persons who provide professional services under agreements with the Sellers have engaged in any activities which are prohibited, or are cause for civil penalties penalties, exceeding $10,000.00 or mandatory or permissive exclusion from Medicare, Medicare or Medicaid, or any other State Health Care Program or Federal Health Care Program under Sections 1320a-7, 1320a-7a, 1320a-7b, or 1395nn of Title 42 of the United States Code (“Title 42”) or Title 31 of the United States Code, the federal CHAMPUS statute, or the regulations promulgated pursuant to such statutes or regulations Laws or related state or local statutes Laws or which are prohibited by any private accrediting organization from which any of the Company Sellers seeks or any Company Subsidiary seeks has accreditation or by generally recognized professional standards of care or conduct, including including, but not limited to to, the following activities: (a) knowingly and willfully 4.9.1 making or causing to be made a false statement or representation of a material fact in any application for any benefit or payment; (b) knowingly and willfully 4.9.2 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; (c) 4.9.3 presenting or causing to be presented a claim for reimbursement under CHAMPUS, Medicare, Medicaid or any other State Health Care Program federal or Federal Health Care Program state health care program that is (i) for an item or service that the person Person presenting or causing to be presented knows or should know was not provided as claimed, or (ii) for an item or service and that the person Person presenting knows or should know that the claim is false or fraudulent, or (iii) for an item or service that the Person presenting knows or should know is not medically necessary; (d) knowingly and willfully 4.9.4 offering, paying, soliciting or receiving any remuneration (including any kickback, bribe, bribe or rebate), directly or indirectly, overtly or covertly, in cash or in kind (i) in return for referring, or to induce the referral of, an individual to a person 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 CHAMPUS, Medicare, Medicare or Medicaid, or any other State Health Care Program federal or Federal Health Care Programstate health care program, or (iiiii) in return for, or to induce, the purchase, lease, lease or order, or the arranging for or recommending of the purchase, lease, lease or order, of any good, facility, service, service or item for which payment may be made in whole or in part by CHAMPUS, Medicare, Medicare or Medicaid or any other State Health Care Program or Federal Health Care Programstate health care program; or (e) knowingly and willfully 4.9.5 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 material fact required to be stated therein or necessary to make the statements contained therein not misleading) or a material fact with respect to (i) the conditions or operations of a facility Business in order that the facility Business may qualify for CHAMPUS, Medicare, Medicaid or any other State Health Care Program federal or Federal Health Care Program state health care program certification, or (ii) information required to be provided under SSA Section 1124A.1320a 3a of Title 42. 4.10. Medicare/Medicaid Participation . 4.10.1 None of the Sellers, nor any of the Sellers’ employees, officers or, to the Seller Parties’ Knowledge, contractors, has been excluded or debarred from participation under the Medicare program, other federal health care program (including, without limitation, the Veteran’s Administration or TRICARE f/k/a CHAMPUS), the Medicaid program or a state health care program as defined in Section 1320a 7 of Title 42 or any regulations promulgated thereunder (“State Health Care Program”); 4.10.2 None of the Sellers, nor any of the Sellers’ employees, officers or, to the Seller Parties’ Knowledge, contractors, has been convicted (as that term is defined in 42 C.F.R. § 1001.2) of any of the following categories of offenses as described in 21 (a) Criminal offenses relating to the delivery of an item or service under Medicare, other federal health care program, Medicaid, or any State Health Care Program; (b) Criminal offenses under any Law relating to neglect or abuse in connection with the delivery of a health care item or service; (c) Criminal offenses under any Law relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of a health care item or service or with respect to any act or omission in a program operated by or financed in whole or in part by any federal, state or local government agency; (d) Any Law relating to the interference with or obstruction of any investigation into any criminal offense described in (i) through (iii) above; (e) Criminal offenses under any Law relating to the unlawful manufacture, distribution, prescription or dispensing of a controlled substance; or (f) Any offense which would permit the exclusion of any Business from a government program.

Fraud and Abuse Matters. Neither the Except as set forth in Schedule 4.34, no Acquired Company nor any Company Subsidiaryis presently, nor the officersor has, directors, employees or agents of any of the Company or any Company Subsidiary, have engaged in any activities which are prohibited, or are cause for criminal or civil penalties or and/or mandatory or permissive exclusion from Medicare, Medicaid, Medicaid or any other State Health Care Program or Federal Health Care Program under Sections 1320a-7, 1320a-7a, 1320a-7b, 1320a-7b or 1395nn of Title 42 of the United States Code, the federal CHAMPUS statute, Federal False Claims Act or the regulations promulgated pursuant to such statutes statutes, or regulations or related similar state or local statutes or regulations, or which are prohibited by applicable statutes, regulations, or ethical codes governing professional conduct or standards of care or by any private accrediting organization from which the Company has or any Company Subsidiary seeks accreditation or by generally recognized professional standards of care or conducthas sought accreditation, including including, but not limited to to, the following activities:activities (as defined in the cited statutory and regulatory provisions): (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; (b) knowingly and or 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; (c) presenting or causing to be presented a claim for reimbursement under CHAMPUS, Medicare, Medicaid Medicaid, or any other State Federal Health Care Program or Federal Health Care Program that is (i) for an item or service that the person presenting or causing to be presented claimant knows or should know was not provided as claimed, or (ii) for an item or service and that is based on a billing code that the person presenting claimant knows or should know that will result in a greater payment to the claim claimant than the billing code the claimant knows or should know is applicable to the item or service actually provided, (iii) for an item or service the claimant knows or should know is false or fraudulentfraudulent or (iv) for an item or service the claimant knows or should know is not medically necessary; (d) any failure by a claimant to disclose knowledge of the occurrence of any event affecting the initial or continued right to any benefit or payment on its own behalf or on behalf of another, with the intent to fraudulently secure such benefit or payment; (e) knowingly and willfully offering, paying, soliciting or receiving any remuneration (including any kickback, bribe, bribe or rebate), directly or indirectly, overtly or covertly, in cash or in kind kind, or offering to pay or receive such remuneration: (i) in return for referring, or to induce the referral of, 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 CHAMPUS, Medicare, Medicaid, or any other State Federal Health Care Program or Federal Health Care Program, or (iiiii) in return for, or to induce, the purchasepurchasing, leaseleasing or ordering or arranging for, or orderrecommending, purchasing, leasing or the arranging for or recommending of the purchase, lease, or order, of ordering any good, facility, service, service or item for which payment may be made in whole or in part by CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program; or (ef) knowingly and willfully making referring any party to a person or causing to be made or inducing or seeking to induce entity in which the making of Company, any false statement or representation (or omitting to state a material fact required to be stated therein or necessary to make the statements contained therein not misleading) or a material fact with respect to (i) the conditions or operations of a facility in order that the facility may qualify for CHAMPUS, Medicare, Medicaid Subsidiary or any other State Health Care Program or Federal Health Care Program certification, or (ii) information required to be provided under SSA Section 1124A.Principal Stockholder has a financial interest that is prohibited by applicable Law.

Fraud and Abuse Matters. Neither the Company nor any Company Subsidiary, Partnership nor the officers, directors, employees or agents of any of either Partnership or the Company or any Company SubsidiaryGeneral Partner, have engaged in any activities which are prohibited, or are cause for civil penalties or mandatory or permissive exclusion from Medicare, Medicare or Medicaid, or any other State Health Care Program or Federal Health Care Program under Sections xx.xx. 1320a-7, 1320a-7a, 1320a-7b, or 1395nn of Title 42 of the United States Code, the federal CHAMPUS statuteCivilian Health and Medical Plan of the Uniformed Services statute ("CHAMPUS"), or the regulations promulgated pursuant to such statutes or regulations regulation, or related state or local statutes or which are prohibited by any private accrediting organization from which the Company or any Company Subsidiary either Partnership seeks accreditation or by generally recognized professional standards of care or conduct, including but not limited to the following activities: (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; (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; (c) presenting or causing to be presented a claim for reimbursement under CHAMPUS, Medicare, Medicaid or any other State Health Care Program as defined in Section 1128(h) of the federal Social Security Act (together with all regulations promulgated pursuant thereto, the "SSA") or any Federal Health Care Program (as defined in Section 1128B(f) of the SSA) that is (i) for an item or service that the person presenting or causing to be presented knows or should know was not provided as claimed, or (ii) for an item or service and the person presenting knows or should know that the claim is false or fraudulent; (d) knowingly and willfully offering, paying, soliciting or receiving any remuneration (including any kickback, bribe, or rebate), directly or indirectly, overtly or covertly, in cash or in kind (i) in return for referring, or to induce the referral of, 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 CHAMPUS, Medicare, Medicare or Medicaid, or any other State Health Care Program or any Federal Health Care Program, or (iii) in return for, or to induce, the purchase, lease, or order, or the arranging for or recommending of the purchase, lease, or order, of any good, facility, service, or item for which payment may be made in whole or in part by CHAMPUS, Medicare, Medicare or Medicaid or any other State Health Care Program or any Federal Health Care Programprogram; 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 material fact required to be stated therein or necessary to make the statements contained therein not misleading) or a material fact with respect to (i) the conditions or operations of a facility in order that the facility may qualify for CHAMPUS, Medicare, Medicaid or any other State Health Care Program or Federal Health Care Program certification, or (ii) information required to be provided under SSA Section ss. 1124A.