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News/Compliance & Enforcement/Express Refusal to Pay Not Only Sign of Materiality
False Claims Act·Compliance & Enforcement Brief

Express Refusal to Pay Not Only Sign of Materiality

The government failed to show that compliance with certain Medicare Advantage requirements was an express condition of payment, but the court found the defendant was aware the government audited providers to recouped payment on the issue and had prosecuted other organizations for similar conduct.

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