Medicare Status Sample Clauses
The Medicare Status clause defines the obligations and representations regarding a party's enrollment or eligibility under the Medicare program. Typically, this clause requires one or both parties to confirm whether they are enrolled in Medicare, and may require notification if their status changes during the term of the agreement. For example, a healthcare provider might need to disclose if they are a Medicare provider, or a patient may need to state if they are a Medicare beneficiary. The core function of this clause is to ensure compliance with federal regulations and proper billing practices, thereby preventing fraud and ensuring that services are billed appropriately to Medicare when applicable.
POPULAR SAMPLE Copied 1 times
Medicare Status. Only Medicare eligibles who are eligible for both Medicare Parts A and B, or Recipients who are eligible for Medical Assistance without Medicare, may enroll.
Medicare Status. Under certain circumstances, federal law requires that a settlement payment that normally would be paid to a class member must instead be paid to Medicare, to reimburse Medicare for money it previously spent on certain medical treatment arising from the class member’s claims (“Conditional Payments”). The information collected in this section is intended to determine if your claim falls into the narrow category of claims that may be affected by this federal law. By submitting this claim form, you agree that if the information you provide in this Section is inaccurate or incomplete, you will indemnify the Releasing Party for any resulting debts or liabilities that Medicare (or anyone acting on Medicare’s behalf) may assert against the Released Party and any attorney’s fees or expenses the Released Party may incur in connection with such debts or liabilities, and that the Released Party will have the right to seek repayment of any claim you may receive.
1. I [was / was not] (circle one) enrolled in the Medicare program at the time of the events giving rise to the claims released in this litigation (i.e., the date I was displaced from the Property, or the date my application for tenancy at the Property was denied, or the date I completed a Guest Card expressing interest in living at the Property) or at any time since then through the date of this Claim Form and Release. IF YOU CIRCLED “WAS NOT”, YOU HAVE COMPLETED SECTION C. SIGN AND DATE THE DECLARATION IN SECTION D. IF YOU CIRCLED “WAS,” PROCEED TO THE NEXT ITEM.
Medicare Status. I represent and warrant that I am not enrolled in the Medicare program, was not enrolled in the Medicare program at the time My Claims arose or anytime thereafter through the date of this Release, and have not received Medicare benefits for medical services or items related to, arising from, or in connection with My Claims. I represent and warrant that no Medicaid payments have been made to or on behalf of me and that no liens, claims, demands, subrogated interests, or causes of action of any nature or character exist or have been asserted arising from or related to My Claims. I further agree that I, and not the Company, shall be responsible for satisfying all such liens, claims, demands, subrogated interests, or causes of action that may exist or have been asserted or that may in the future exist or be asserted.