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Express and Implied False Certifications Legally false certification claims fall into two categories: express false certifications and implied false certifications. In this case addressing FCA liability for false certification of compliance with Department of Education regulations, the Ninth Circuit found that a false promise of future compliance could be the basis for liability under the FCA. , the court held that if the express certification does not specifically state that compliance is a prerequisite to payment, the court “must look to the underlying statutes to surmise if they make the certification a condition of payment.” The court rejected the notion that a very broad certification of compliance with all health care laws and regulations could satisfy the specific requirements of the FCA.
However, in so finding, the court explicitly differentiated its holding from and other cases arising in the health care context. Conner alleged that Salina Regional Health Center (SRHC) submitted false certifications of compliance in its annual cost reports, in which health care providers notify the government of over- and under-payments resulting from Medicare bills submitted throughout the year.
Article VIII, section 1-b(h)Texas Constitution, a municipality with an ad valorem tax rate of zero, upon receiving a properly filed petition from five percent of authorized voters, must hold an election to determine whether to freeze the total amount of ad valorem taxes imposed on property that is subject to a residence homestead exemption owned by a person that is disabled or is 65 years of age or older under Local option homestead exemption from the amount that was adopted for the 2014 tax year through the 2019 tax year; Tax Code subsection 11.13(n-1) prohibits a school district, municipality, or county from repealing or reducing the Absent a constitutional amendment, a county may not form and operate a county energy transportation reinvestment zone ("CETRZ"), a tax increment reinvestment zone ("TIRZ"), or a transportation reinvestment zone ("TRZ") to the extent that doing so utilizes a pledge of the captured increment of ad valorem taxes to fund a county tax increment reinvestment zone.
JM-1179 (1990))Serving as the state chair of a political party, because the state chair of a political party does not hold an office or position under this State a member of the Legislature is not barred from under either article III, section 19 or article XVI, section 40(d) of the Texas Constitution from Vacancy on municipal governing body where officers hold terms longer than two year must be filled under article XI, section 11(b) of the constitution, which prevails over inconsistent city charter provisions A court would likely hold that a judge's award of diligent participation credit under Code of Criminal Procedure subsection 15(h)(6) does not interfere with an expressly granted executive power and thus does not violate article II, section 1Appellate court employment policies and procedures, review by Texas Commission on Human Rights for compliance with Texas Human Rights Act and exaction of monetary penalty for noncompliance does not violate separation of powers provision City council member whose current term is uncompensated, article III, section 19 of the Texas Constitution does not render ineligible to serve in the Texas Legislature; "term" is not synonymous with "tenure"Score and rank applications for low-income-housing credits based in part on written statements from state elected officials, statute which requires Texas Department of Housing & Community Affairs to do so does not violate article II, section 1, Separation of Powers doctrine of Constitution Statute that appears to delegate authority to private entity which promulgates codes for installation, alteration, operation, and inspection of elevators, escalators, and related equipment must be construed to incorporate only those editions of codes that Texas Triple Chance, a court is unlikely to conclude that a game is unconstitutional merely because it awards a preset prize amount regardless of the number of tickets purchased or because it does not carry forward any unpaid prize money to be awarded to an eventual winner A county equalization tax under former chapter 18, Education Code, appears to provide a county school board operating thereunder meaningful discretion with regard to the tax such that a court could determine that the tax is not constitutionally infirm under article VIII, section 1-e.
If, after these conditions are satisfied, the provider remains substantially noncompliant, Medicare program participation may eventually be terminated.
Conditions of payment, on the other hand, “are those which, if the government knew they were not being followed, might cause it to actually refuse payment.” , a Ninth Circuit case decided in 2010, the plaintiff alleged that defendant was engaging in the illegal corporate practice of medicine, violating the Stark Law’s prohibitions against self-referrals and illegally billing Medicare for services provided by physician employees who had significant financial interests in the billing entity, a home health agency.
The court noted that the Medicare statutes have many ways of enforcing underlying laws and regulations, including a plan of correction, a reasonable time period to address deficiencies, and the opportunity to correct billing practices.
The court found that Ebeid’s allegations were unsubstantiated by the complaint and affirmed the lower court’s dismissal with prejudice. The Stark Law provides that a physician cannot refer Medicare patients to an entity in which the physician has a prohibited financial interest.
However, the court also found that the Stark Law and the Medicare regulations implicated in Ebeid’s suit could have formed the basis for an FCA suit if they had been properly pled. In part, the Stark Law provides that “no payment may be made” for services rendered because of a prohibited referral.
Failure to comply with a condition of payment can result in the denial of the claim for payment or, if the payment has already been made, the amount paid on the claims is considered an overpayment that must be refunded under current law. While a provider may eventually be excluded from the federal health care program, exclusion is relatively rare and only occurs if the provider fails to become substantially compliant during the corrective period.
The distinction between a condition of payment and a condition of participation has been—and should continue to be—of particular significance in actions brought under the federal False Claims Act (FCA). Conditions of Participation In contrast, if the condition or requirement that has not been satisfied relates not to a prerequisite for payment but to a condition of participation in a federal health care program, the outcome is less clear, as a claim may be eligible for payment even if a provider is out of compliance with one or more conditions of participation at the time the claim is submitted. Conditions of participation are typically minimum health and safety standards focused on quality of care provided. For that reason, a number of courts have recognized that it would be both inappropriate and premature for the government to refuse to pay otherwise appropriate claims on the basis that the provider failed to fulfill all conditions of participation. Specifically, the plaintiff alleged that spirometry tests were performed without testing devices being properly calibrated, which made the doctors noncompliant with various Medicare regulations. Defendants had submitted claims on a form that stated: “I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished incident to my professional service by my employee under my immediate personal supervision.” The court noted that both the form on which the claims were submitted and the Medicare regulations stated that certification is a precondition to Medicare reimbursement. The court held that defendants’ certification found on the claim form was a precondition of government payment for those claims.