Payment Programs Clause Samples

Payment Programs. All Company Payment Programs and provider numbers for each Company Payment Program are listed on Schedule 5.17. Company is a provider, in good standing, in each Company Payment Program. There is no pending, concluded or, to the knowledge of Company, threatened investigation, or civil, administrative or criminal proceeding relating to Company’s participation in any Payment Program, except as disclosed on Schedule 5.17. Company is not subject to, nor has it been subjected to, any pre-payment utilization review or other utilization review by any Payment Program. No Payment Program has requested or threatened any recoupment or set-off from Company and there is no basis therefor. Company has paid, repaid, allowed to be offset or caused to be paid all known and undisputed refunds, overpayments, discounts or adjustments. There are no pending appeals, challenges, audits, inquiries, litigation or notices of intent to audit with respect to any prior reports or ▇▇▇▇▇▇▇▇. Except as disclosed on Schedule 5.17, during the last two (2) years Company has not been audited or otherwise examined by any Payment Program. No Payment Program has imposed a fine, penalty or other sanction on Company. Neither Company nor any of its Affiliates has been excluded from participation in any Payment Program. Company has not submitted to any Payment Program any false or fraudulent claim for payment, nor has Company at any time violated any condition for participation, or any rule, regulation, policy or standard of any Payment Program. All Medicare, Medicaid and third party reports and claims filed or required to be filed by or on behalf of Company have been timely filed and are complete and accurate in all respects. Such reports and claims properly claim and disclose all information and other items to be disclosed for the periods covered thereby. Neither Company nor any of Company’s Affiliates, directors, Members, officers, employees or agents, has directly or indirectly: (i) offered to pay to or solicited any remuneration from, in cash, property or in kind, or made any financial arrangements with, any past or present patient or customer, or physician, other health care provider, supplier, contractor, third party, or Payment Program in order to induce or directly or indirectly obtain business or payments from such person, including without limitation any item or service for which payment may be made in whole or in part under any federal, state or private health care program, or for purcha...

Payment Programs. All payment programs in which the Existing Operator participates are listed on Schedule 3.1(b)(xiv) (collectively, the “Payment Programs”). Except as set forth on Schedule 3.1(b)(xiv), Existing Operator is a participating provider, in good standing, in compliance with the conditions of participation of the Payment Programs in which they participate with valid and current provider agreements. Except as identified on Schedule 3.1(b)(xiv), each such provider agreement may not be transferred to New Operator without consent of the counterparty. Except as set forth on Schedule 3.1(b)(xiv), there is no pending or to Existing Operator’s knowledge, threatened investigation, or civil, administrative proceeding relating to participation in any Payment Program nor have any such proceedings been concluded since January 1, 2022 that are material either individually or in the aggregate. Except as set forth on Schedule 3.1(b)(xiv), Existing Operator and the Facility are not subject to, nor has been subjected to at any time since January 1, 2022, any utilization review by any Payment Program. Except as set forth on Schedule 3.1(b)(xiv), since January 1, 2022, no Payment Program has requested or threatened, any recoupment, refund, or set-off from Existing Operator or Facility. Except as set forth on Schedule 3.1(b)(xiv) since January 1, 2022 no Payment Program has imposed a fine, penalty or other sanction on Existing Operator or the Facility. Neither Existing Operator nor any current employee of Existing Operator have been excluded from participation in any Payment Program. Existing Operator has not hired or contracted with any person or entity that is listed as “excluded” on the United States Office of the Inspector General or the HFR website. To Existing Operator’s knowledge, Existing Operator has not submitted to any Payment Program any false or fraudulent claim for payment, nor has Existing Operator at any time violated any condition for participation, or any rule, regulation, policy or standard of, any Payment Program, the violation of which would be materially adverse to Existing Operator or the Facility. All billing practices of Existing Operator with respect to the business and the Facility have been in compliance with all applicable laws and policies of each Payment Programs in all material respects. Existing Operator has not received notice or communication that Existing Operator has billed or received any payment or reimbursement in excess of amounts permitted by...

Payment Programs. To the extent that New Operator can demonstrate commercially reasonable efforts to qualify as providers, New Operator shall be satisfied, at their reasonable discretion, that they shall be able to enter into written participation agreements, effective as of the Closing and on terms and conditions consistent with the marketplace, with any of the current commercial third party payors holding an agreement with the Facility and consisting of more than five percent (5%) of the Facility gross revenue.

Payment Programs. Neither Seller, nor any of Target’s officers or employees, nor, to the best knowledge of Seller, Target’s agents has received written notice that it is subject to any restriction or limitation on the receipt of payment under the Medicare or Medicaid programs, any other federally funded health care program or any other third party payor (collectively, the “Payment Programs”). Target has valid and current provider agreements with the Payment Programs. Target is in compliance in all material respects with the conditions of participation for the Payment Programs. Neither Seller, nor any of Target’s officers or employees, nor, to the best knowledge of Seller, Target’s agents has received written notice that a Payment Program has requested or threatened any recoupment, refund or set-off from Target, or imposed any fine, penalty or other sanction on Target, nor has Target been excluded from participation in a Payment Program. Target has not submitted to a Payment Program any false or fraudulent claim for payment, nor has Target at any time violated in any material respect any condition for participation, or any published rule, regulation, policy or standard of a Payment Program.

Payment Programs. As of the date of this Agreement, except as set forth in Section 5.03 of the Company Disclosure Letter, the Company and each Subsidiary meets, or is actively engaged in remediating issues identified through ordinary course survey or audits (as they relate to Company Payment Programs), the applicable material requirements of participation, coverage, and enrollment for, and where applicable, are parties to valid supplier or participation agreements related to all Company Payment Programs in which the Company and each Subsidiary participates in connection with the Hospital Business, in whole or in part, except as would not reasonably be expected to have, individually or in the aggregate, a Hospital Material Adverse Effect. As of the date of this Agreement, to the Knowledge of the Company, and other than ordinary course surveys, audits or denials, neither the Company nor any Subsidiary has received any written notice of any action pending by any Company Payment Program, either to revoke, limit, or terminate the participation for cause of the Company or any of the Subsidiaries in any Company Payment Program. Other than ordinary course surveys or audits (as they relate to Company Payment Programs), to the Knowledge of the Company, no event has occurred which, with the giving of notice, the passage of time, or both, would constitute grounds for termination in the participation of the Company or any of its Subsidiaries with respect to the Hospital Business in any Company Payment Program. The Company Payment Programs to which the Company or any Subsidiary is a party constitute valid and binding obligations on the Company or its applicable Subsidiaries who are parties thereto, enforceable against it in accordance with its terms. Other than ordinary course surveys or audits (as they relate to Company Payment Programs), neither the Company nor any Subsidiary has received notice of default of any material provision under any Company Payment Program and, to the Knowledge of Company and each Subsidiary, the other parties thereto are not in default of any material provision thereunder, except as would not reasonably be expected to have, individually or in the aggregate, a Hospital Material Adverse Effect. Other than ordinary course audits, surveys or payment adjustments, to the Knowledge of the Company, there is no pending, concluded or threatened civil, administrative or criminal proceeding relating to the participation by the Company or any Subsidiary in any Company Pay...

Payment Programs. Except as set forth on SCHEDULE 2.33 of the Sellers' Disclosure Schedule (a) neither Seller, Target nor any of its employees or agents have received notice that it is subject to any restriction or limitation on the receipt of payment under the Medicare or Medicaid programs, any other federally funded health care program or any other third party payor (collectively, the "PAYMENT PROGRAMS"), (b) Target has valid and current provider agreements with the Payment Programs, and (c) Target is in compliance with the conditions of participation for the Payment Programs. Neither Sellers nor Target have received written notice that a Payment Program has requested or threatened any material recoupment, refund, or set-off from Target, or imposed any material fine, penalty or other sanction on Target nor has Target been excluded from participation in a Payment Program. Target has not submitted to a Payment Program any material false or fraudulent claim for payment, nor has Target at any time violated any material condition for participation, or any published rule, regulation, policy or standard of a Payment Program.

Payment Programs. Please call us if you would like to obtain additional information about whether you qualify for any of our payment plans such as our automated bank draft arrangements.

Payment Programs. Schedule 2.16 sets forth all Payment Programs in which any Acquired Company has participated at any time since January 1, 2013 (the “Acquired Company Payment Programs”). Each Acquired Company is a participating supplier or provider, in good standing, in each of the Acquired Company Payment Programs in which it currently participates. No civil, administrative or criminal proceedings relating to any Acquired Company’s participation in any Payment Program, are pending, or, to the Knowledge of the Company, threatened or reasonably foreseeable, nor has any such proceeding concluded since January 1, 2013. Except as set forth in Schedule 2.16, no Acquired Company is subject to, nor has any Acquired Company been subject to since January 1, 2013, any pre-payment utilization review or other utilization review by any Payment Program. Except as set forth in Schedule 2.16, no Payment Program is currently requesting or has requested since January 1, 2013 or, to the Knowledge of the Company, is threatening or has since January 1, 2013 threatened, any recoupment, refund, or set-off from any Acquired Company totaling $20,000 or more individually or $200,000 in the aggregate. No Payment Program has imposed any fine, penalty or other sanction on any Acquired Company since January 1, 2013. No Acquired Company has been suspended, excluded, or otherwise been the subject of any adverse action taken by any Payment Program since January 1, 2013. Except as set forth in Schedule 2.16, none of the Acquired Companies has, since January 1, 2013, submitted to any Payment Program, any false or fraudulent claims for payment, nor has any Acquired Company violated in any material respect any condition of participation, or any other rule, regulation, policy or standard of, any Payment Program.

Payment Programs. Section 2.19 of the Company Disclosure Schedule contains a list of all commercial insurance plans and Government Healthcare Programs in which a Clinical Entity is a participating provider (“Clinical Payment Programs”). Except as set forth in Section 2.19 of the Company Disclosure Schedule, there is no Proceeding, active or pending or, to the Company’s knowledge, threatened, relating to a Clinical Entity’s participation in any of the Clinical Payment Programs or violation of Healthcare Laws. No Clinical Entity is subject to any non-routine prepayment utilization review or other non-routine utilization review by any Clinical Payment Program, and, except as set forth in Section 2.19 of the Company Disclosure Schedule, no Clinical Payment Program has requested or, to the Company’s knowledge, threatened any recoupment, refund, or set-off from any Clinical Entity, or imposed any fine, penalty or other sanction on any Clinical Entity, nor has any Clinical Entity been excluded from participation in any Clinical Payment Program. No Clinical Entity has submitted to any Clinical Payment Program any false or fraudulent claim for payment. No Clinical Entity has violated any condition for participation, or any published rule, regulation, policy or standard of any Clinical Payment Program in any respect, in each case, except as set forth in Section 2.19 of the Company Disclosure Schedule. The Clinical Entities have, since the date three years prior to the date of this Agreement, complied in a timely manner with any applicable notice requirements of Clinical Payment Programs, and of any applicable provider/payor agreements with Clinical Payment Programs, regarding provision of notice of the transactions contemplated by this Agreement. Neither any Clinical Entity nor any Clinical Provider has been subject to a judgment or has repaid any overpayment relating to Clinical Payment Programs. Except as set forth on Section 2.19 of the Company Disclosure Schedule, the Clinical Entities have not billed or received any payment or reimbursement in excess of amounts allowed by Law except as and to the extent that liability for such overpayment has already been refunded to such Clinical Payment Programs or is adequately reserved.