Medicare/Medicaid Clause Samples

Medicare/Medicaid. The parties hereto understand and agree that the exercise of remedies hereunder with respect to receivables from Medicare or Medicaid may be subject to applicable federal laws.

Medicare/Medicaid. Enrollee (or Enrollee) — For the purposes of this Demonstration, an individual who is entitled to, or enrolled for, benefits under Part A of title XVIII of the Social Security Act, and enrolled for benefits under Part B of title XVIII of such Act, and is eligible for medical assistance under a State plan under title XIX of such Act or under a waiver of such plan.

Medicare/Medicaid. LH shall continue to participate in the Medicare and Medicaid programs and maintain the necessary licenses for LH’s general acute care hospitals in Lee County to participate in the Medicare and Medicaid programs, and it shall continue serving Medicare and Medicaid patients in Lee County at levels consistent with such levels over the past five (5) years, absent a Significant Change;

Medicare/Medicaid. The Patient understands that ▇▇. ▇▇▇▇ is opted out of Medicare/Medicaid. As a result, both the Patient and the Practice shall be prohibited by law from seeking reimbursement from Medicare/Medicaid for any Services provided under this Agreement. Accordingly, the Patient agrees not to submit bills or seek reimbursement from Medicare/Medicaid for any such services. Furthermore, if the Patient is eligible or becomes eligible for Medicare/Medicaid during the term of this Agreement, the Patient agrees to immediately inform the Practice and sign the Medicare/Medicaid private contract as provided and required by law. ▇▇. ▇▇▇▇ will not be responsible for paperwork relating to coverage of products and services provided outside of the Practice.

Medicare/Medicaid. The Company will use reasonable best efforts to cause USPGI to be operated in substantial compliance with the conditions and standards of participation in, and the rules and regulations of, the Medicare and Medicaid programs.

Medicare/Medicaid. El paciente comprende que el ▇▇. ▇▇▇▇ se excluye de Medicare/Medicaid. Como resultado, tanto el Paciente como la Práctica tendrán prohibido por ley solicitar el reembolso de Medicare/Medicaid por cualquier Servicio proporcionado bajo este Acuerdo. En consecuencia, el paciente acepta no enviar facturas ni buscar el reembolso de Medicare/Medicaid por dichos servicios. Además, si el Paciente es elegible o se vuelve elegible para Medicare/Medicaid durante el término de este Acuerdo, el Paciente acepta informar inmediatamente a la Práctica y firmar el contrato privado de Medicare/Medicaid según lo dispuesto y requerido por ▇▇ ▇▇▇. El ▇▇. ▇▇▇▇ no será responsable del papeleo relacionado con la cobertura de productos y servicios proporcionados fuera de la Práctica.

Medicare/Medicaid. Plan (MMP) -- A health plan contracted with DHCS and CMS to comprehensively manage the full continuum of Medicare and Medi- Cal benefits for Medicare-Medicaid Enrollees including Long Term Supports and Services as needed and desired by the Enrollee.

Medicare/Medicaid. As of the date hereof, no resident at any Facility is a participant in Medicare, Medicaid or other public payor program with respect to such resident's fees or other services payable to SDI, SALII, SALI, any Facility Owner, or Manager. To Sunrise's knowledge, no action, proceeding, or investigation in connection with Medicare, Medicaid or other public or private third-party payor or other programs is pending or threatened against Sunrise in connection with the Facilities. Sunrise has not received notice of any threatened or pending investigation in connection with (i) Medicare, Medicaid, or other public or private third-party payor programs or (ii) any fraud, false statement or false claim applicable to its business or (iii) any patient care, patient rights or other law applicable to its business. Sunrise has prepared and filed all cost reports, if any, that were required to be filed for Medicare and Medicaid purposes and for all other public or private third-party reimbursement programs through the date of this Agreement. All such cost reports, if any, are correct and accurate and have been prepared in conformity with Sunrise's books and records. Sunrise has not received notice that Medicare, Medicaid or any other public or private third-party payor has any claims for disallowance of costs against it. To Sunrise's knowledge, Sunrise has not committed any violation of the Medicare and Medicaid fraud and abuse provisions of the Social Security Act, any similar state law or Title VI of the Civil Rights Act.

Medicare/Medicaid. Except as set forth in this Section 4.15 and on Schedule 4.15, no material portion of the income from any Property is attributable to Medicare, Medicaid or any public or private third-party payor or other program, except for certain payment from private insurers pursuant to long-term care policies. (a) Tenant is receiving payment under Titles XVIII and XIX of the Social Security Act and is certified for participation in those governmental payor programs (“Governmental Payor Programs”), including but not limited to the Medicare programs, and is a party to valid participation agreements for payment by the Governmental Payor Programs, which agreements are in full force and effect. Without limiting the generality of the foregoing, the facilities, equipment, staffing and operations of Tenant satisfy all material conditions of participation in the Governmental Payor Programs. Tenant has not received notice of pending, threatened or possible investigation by, or loss of participation in, any Governmental Payor Programs, and there is no basis for any such notice. (b) There are no pending or threatened material claims (including potential penalties) by any of such Governmental Payor Programs against Tenant, and Tenant has not been subject to loss of waiver of liability for utilization review denials with respect to any such Governmental Payor Programs since May 2012. (c) All billing practices of Tenant with respect to Governmental Payor Programs and private insurance companies have been in material compliance with Applicable Laws, and Tenant has not billed or received any payment or reimbursement in excess of amounts allowed by Applicable Laws. (d) Tenant has not, in material violation of the requirements of any Government Payor Program, (i) offered or paid any remuneration, in cash or in kind, to, or made any financial arrangements with, any past, present or potential customers, past or present suppliers, patients, medical staff members, contractors or third-party payors of Tenant in order to obtain business or payments from such persons other than in the ordinary course of business; (ii) given or agreed to give, or is aware that there has been made or that there is any agreement to make, any gift or gratuitous payment of any kind, nature or description (whether in money, property or services) to any customer or potential customer, supplier or potential supplier, contractor, third party-payor or any other person other than in connection with promotional or enterta...