• No Access Clause, No Medicare Reimbursement
  • September 11, 2003
  • Law Firm: Foley & Lardner LLP - Los Angeles Office
  • The Provider Reimbursement Review Board issued a decision holding that if a provider subcontracts for services worth over $10,000 per year, the costs are not allowable for Medicare reimbursement unless the subcontract has a clause allowing access to the subcontractor's books and records. This decision is a reminder that Medicare's "access clause" requirement may be strictly enforced. Providers should confirm that their contracts comply. Providers should also consider potential consequences of cost reports that include costs from contracts that do not comply. Depending on the circumstances, the knowing submission of such a cost report may be viewed as a false claim.