Medicare and Medicaid. No Credit Party and no Subsidiary of any Credit Party directly bills, receives direct reimbursement from, or otherwise participates in Medicare (Title XVIII of the Social Security Act) and the regulations promulgated thereunder or Medicaid (Title XIX of the Social Security Act) and the regulations promulgated thereunder or any other Federal Health Care Program.
Medicare and Medicaid. If Borrower or any Facility Operator or Property Manager participates in any Governmental Payor Program in connection with the operation of the Facility, all of the following are true:
(a) The Facility is in compliance in all material respects with the requirements for participation in the Governmental Payor Program, including without limitation, the Medicare and Medicaid Patient Protection Act of 1987.
(b) The Facility conforms in all material respects to all insurance, reimbursement and cost reporting requirements, and has a current provider agreement under Title XVIII and/or XIX of the Social Security Act or any other applicable laws for reimbursement necessary for its Intended Use.
(c) There Except as disclosed to Lender, there is no action pending or, to the best of Borrower’s knowledge after due inquiry and investigation, threatened to terminate the Facility’s participation in the Governmental Payor Program nor is there has Borrower or any Facility Operator received written notice of any decision not to renew any provider agreement related to the Facility, nor is there any action pending or threatened to impose material intermediate or alternative sanctions with respect to the Facility.
(d) All Governmental Payor Program and private insurance cost reports and financial reports submitted by Borrower, any Facility Operator, or any Property Manager for the Facility are and will be materially accurate and complete and have not been and will not be are not misleading in any material respects respect.
(e) No cost reports for the Facility remain “open” or unsettled, except as otherwise disclosed in writing to Lender.
(f) TheExcept as disclosed in writing to Lender, (i) the Facility has not received a “Level A” (or equivalent) violation, and(ii) no statement of charges or deficiencies has been made or penalty enforcement action has been undertaken against the Facility, any Property Manager or Facility Operator or the Borrower (or any officer, director or stockholder of any of the foregoing) during the last 3 calendar years, and (iii) there have been no violations over the past 3 calendar years which have threatened any certification of the Facility, any Property Manager or Facility Operator or the Borrower for participation in any Governmental Payor Program.
(g) There are no resident care agreements with residents of the Facility or with any other Persons which deviate in any material respect from the standard forms disclosed to Lender and customarily used a...
Medicare and Medicaid. As of the date of this Agreement, USPGI is qualified for participation in and is a participant in the health insurance program for the aged and disabled created under Title XVIII of the Social Security Act, as amended (the “Social Security Act”) (“Medicare”), and USPGI is qualified for participation (or has applied for qualification for participation) in the appropriate state Medicaid program supported by grants from the federal government under Title XIX of the Social Security Act (“Medicaid”), to the extent that USPGI participates therein. As of the date of this Agreement, the operation of USPGI is in substantial compliance with the conditions and standards of participation in, and the rules and regulations of the Medicare and Medicaid programs. As of the date of this Agreement, there are no material disputes, audits (other than audits in the ordinary course), investigations, inquiries or claims pending or, to USPGI’s knowledge, threatened involving USPGI and such reimbursement programs, and, to USPGI’s knowledge, there is no basis for any such material dispute or claim.
Medicare and Medicaid. Except as otherwise described in the General Disclosure Package or as would not reasonably be expected to have a Material Adverse Effect, all facilities owned, operated or managed as continuing operations by the Company (i) are licensed, to the extent necessary, under appropriate state laws to conduct their business as described in the General Disclosure Package; (ii) are certified for participation or enrollment in the Medicare and Medicaid programs; (iii) have the benefit of a current and valid provider contract with the Medicare and Medicaid programs and (iv) are in substantial compliance with the terms and conditions of participation in such programs and have received all approvals or qualifications necessary for reimbursement. To the knowledge of the Company, the amounts established as provisions for Medicare and Medicaid adjustments and adjustments by any other third-party payors on the consolidated financial statements of Holdings are sufficient in all material respects to pay any amounts for which Holdings or its subsidiaries may be liable for such adjustments. Except as described in the General Disclosure Package, the Company has not received notice from the regulatory authorities which enforce the statutory or regulatory provisions in respect of the Medicare or Medicaid programs of any pending or threatened investigations, surveys (other than routine surveys) or decertification proceedings, and to the Company’s knowledge, no such investigation, survey or proceeding is threatened or imminent, in each case, except such notices or threatened investigations, surveys or proceedings which, individually or in the aggregate, would not reasonably be expected to have a Material Adverse Effect.
Medicare and Medicaid. (a) Borrower represents and warrants that neither Borrower nor any management agent for the Mortgaged Property or any operator of the Mortgaged Property currently participates in any Medicaid programs, Medicare programs or any other third party payors’ programs or other similar provider payment programs in connection with the operation of the Mortgaged Property.
(b) Without the prior written consent of Lender, which may be granted or withheld in Lender’s discretion, Borrower shall not, and shall not permit any management agent for the Mortgaged Property or any operator of the Mortgaged Property to, participate in Medicare or Medicaid, or any provider agreement under Medicare or Medicaid, or accept any resident whose ability to reside in the Mortgaged Property requires that Borrower, the Mortgaged Property or any management agent for the Mortgaged Property or any operator of the Mortgaged Property participate in Medicare, Medicaid or any similar provider program.
(c) In addition to the Events of Default listed in Sections 22 and 55, it also shall constitute an Event of Default if Borrower participates, or permits any management agent for the Mortgaged Property or operator of the Mortgaged Property to participate, in Medicare, Medicaid, or any similar or successor payment provider plan.”
Medicare and Medicaid. Except as would not, individually or in the aggregate, result in a Material Adverse Effect, the Company is in compliance in all material respects with all applicable laws, statutes, ordinances, rules or regulations with respect to Medicare and Medicaid (including, without limitation, all provisions of the Social Security Act pertaining to Medicare and Medicaid and The False Claims Act).
Medicare and Medicaid. You acknowledge and agree that you do not receive health insurance under the Medicare or Medicaid program or a Medicare Advantage or managed Medicaid plan. DPC Practitioners currently cannot provide services to Medicare or Medicaid beneficiaries under the terms of a Medical Retainer Agreement.
Medicare and Medicaid. Sellers and the Practice are in compliance with all laws, rules and regulations of Medicare, Medicaid and other governmental health care programs, and have filed all claims and other forms in the manner prescribed by such laws, rules and regulations. To the knowledge of Sellers there is no basis for any material claim or request for recoupment or reimbursement from Sellers by, or for reimbursement by Sellers of, any federal or state agency or instrumentality or other provider reimbursement entities. No deficiency (either individual or in the aggregate) in any such claims, returns, invoices, cost reports and other filings, including claims for overpayments or deficiencies for late filings, has been asserted or, to the knowledge of Sellers threatened by any federal or state agency or instrumentality or other provider reimbursement entities and, to the knowledge of Sellers there is no reasonable basis for any claims or requests for reimbursement.
Medicare and Medicaid. Except as set forth on Schedule 6.1(j) attached hereto, each Facility participates in the Medicare and Medicaid programs, is eligible to receive payment under Title XVIII of the Social Security Act, as amended (the "SOCIAL SECURITY ACT"), and is a "provider" under a provider agreement with the Medicare program. With respect to such provider agreements, neither Magellan nor any Subco has received a notice of termination, is in default in any material respect, or has any knowledge that any other party to such agreements is in default thereunder.
Medicare and Medicaid. The Company and its --------------------- Subsidiaries have complied in all material respects with all Medicare and Medicaid laws, rules and regulations and have filed all returns, cost reports and other filings in the manner prescribed, except where the failure to do so would not have or reasonably be expected to have, individually or in the aggregate, a Company Material Adverse Effect. All returns, cost reports and other filings made by the Company and its Subsidiaries to Medicare, Medicaid or any other governmental health or welfare related entity or any other third party payor are in all material respects true and complete, except where the failure to be so would not have or reasonably be expected to have, individually or in the aggregate, a Company Material Adverse Effect. No deficiency in any such returns, cost reports and other filings, including deficiencies for late filings, has been asserted or, to the Company's knowledge, threatened by any federal or state agency or instrumentality or other provider reimbursement entities relating to Medicare or Medicaid claims or third party payor, and, to the knowledge of the Company, there is no basis for any claims or requests for reimbursement from any such agency, instrumentality, entity or third party payor except for any deficiencies which would not have or reasonably be expected to have, individually or in the aggregate, a Company Material Adverse Effect. Neither the Company nor any of its Subsidiaries has been subject to any audit relating to fraudulent Medicare or Medicaid procedures or practices, except for audits which would not have or reasonably be expected to have, individually or in the aggregate, a Company Material Adverse Effect.
