Common use of Failure to comply with Clause in Contracts

Failure to comply with. FEDERAL LAWS AND REGULATIONS Failure of HMO to comply with the federal requirements for Medicaid, including but not limited to, federal law regarding misrepresentation, or fraud, or abuse; and, by incorporation, Medicare standards, requirements, or prohibitions, is a default of this contract. The following events are defaults under this contract pursuant to 42 USC Sections 1396b(m)(5), 1396u-2(e)(1)(A): 16.3.4.1 HMO's substantial failure to provide medically nary items and services that are required under this contract be provided to Members; 16.3.4.2 HMO's imposition of premiums or charges on Members in excess of the premiums or charges permitted by federal law; 16.3.4.3 HMO's acting to discriminate among Members on the basis of their health status or requirements for health care services, including expulsion or refusal to enroll an 123 Dallas Service Area Contract 130 individual, except as permitted by federal law, or engaging in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment with HMO by eligible individuals whose medical condition or history indicates a need for substantial future medical services; 16.3.4.4 HMO's misrepresentation or falsification of information that is furnished to HCFA, TDH, a Member, a potential Member, or a health care provider; 16.3.4.5 HMO's failure to comply with the physician incentive requirements under 42 USC Section 1396b(m)(2)(A)(x); or 16.3.4.6 HMO's distribution, either directly or through any agent or independent contractor, or marketing materials that contain false or misleading information, excluding materials prior approved by TDH.

Failure to comply with. FEDERAL LAWS AND REGULATIONS Failure of HMO to comply with the federal requirements for Medicaid, including including, but not limited to, federal law regarding misrepresentation, or fraud, or abuse; and, by incorporation, Medicare standards, requirements, or prohibitions, is a default of under this contract. The following events are defaults under this contract pursuant to 42 USC U.S.C. Sections 1396b(m)(5), 1396u-2(e)(1)(A): 16.3.4.1 HMO's substantial failure to provide medically nary necessary items and services that are required under this contract to be provided to Members; 16.3.4.2 HMO's imposition of premiums or charges on Members in excess of the premiums or charges charge permitted by federal law; 16.3.4.3 HMO's acting to discriminate among Members on the basis of their health status or requirements for health care services, including expulsion or refusal to enroll an 123 Dallas Service Area Contract 130 individual, except as permitted by federal law, or engaging in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment with HMO by eligible individuals whose medical condition or history indicates a need for substantial future medical services; 16.3.4.4 HMO's misrepresentation or falsification of information that is furnished to HCFA, TDH, a Member, a potential Member, or a health care provider; 16.3.4.5 HMO's failure to comply with the physician incentive requirements under 42 USC U.S.C. Section 1396b(m)(2)(A)(x); oror 1999 Renewal Contract Harr▇▇ ▇▇▇vice Area August 9, 1999 16.3.4.6 HMO's distribution, either directly or through any agent or independent contractor, or of marketing materials that contain false or misleading information, excluding materials prior approved by TDH.