be the apple he should understand it although the minutes don't seem to line up correctly or bad in a balanced fashionable sides of the vein that's just to keep the trains running somewhat on time and  the court intends to be generous to make sure that there is balance requirements that are so central to the provision of mental health counseling but the medicaid program were not paying these claims i didn't know none of these royal asians are those the findings of the supreme court it didn't ask this court to partner the deciding party mood that would be material to his payment decision third or look at we can look at the communications of the government agency what has the government agency told the way related to the people who are this because there would be overriding concerns particularly agency decisions as to why agencies are paid to claim the claims he can see on like a private payer isn't always to get the most money for his good could affect it is the opposite situation where you said no you didn't even try and get the payment back you didn't do it which is says you should have demanded that payment back immediately and if you didn't do it we're going to take away your best interest and records as your argument if if for example the regulators reason for not going back for for example is that it wants to service it doesn't want to interrupt service isn't people who operate on a business model and who wants to keep  money flowing and what if the what if the case is going to bankrupt that provider who didn't do the regular also can step in the state can step in both the state and federal government step in and take over and i've seen a case of big think it's should have an obligation before you file the complaint to go to the regulator and ask whether they would always pay would never pay would sometimes pay so that you can you can assert that in the  do that without explicit evidence of turning one from the daughter and i don't know how you can distinguish i don't know how the defendants in fact can get out and say well that's only material to the enforcement decision it's not material to the pavement they slide so easily into one another and i don't know in the real world whether you can make a clear on a stove no it's only for what we're doing here and i don't think we have to make that distinction again we're talking about allegations is it plausible that this was the second factor the supreme court and a five are in this discussion is the importance of the requirements to the program just sort of doesn't go to the essence of the bargain and we think that's really pretty self evident in this case we're paying for psychiatric services  essence of the party why isn't that enough well i think it could be enough i think that again soon to not think that it required or you did that you had to allege more than one of the potential factors i don't think the supreme court problem is that she the regulator may have a variety of reasons this is doing what it does absolutely say that on balance we want to keep this particular company going forward because there know that you do not have a license psychiatry's sin you need to get one within a year from this date in the meantime we will we will pay the claims that come forward it's sort of the the hypothetical money yes or not let's assume that there's a difference between what the federal government would consider appropriate you represent the federal government and what a state agency may decide upon sort of looking at the statutes that say where we're going to pay for these services and since as you said saying we're going to pay for the services when proper supervision and proper licensing you know it has been provided those things go to the government's you know if you think it should go away for whatever reason because it's a good idea because it's interfering with the potentially guys the threat of trouble damages that will bankrupt this you know provider what it was or if what is the commonwealth of massachusetts right to of the regulation with ministry of action that the government might take that is not what materiality under they get ca is about the supreme court made i believe this is crystal clear the supreme court said it must be material to the payment decision not material or rather not important in some abstract sense immaterial to the payment decision so that i'd like you to start right here with my my question is this if i contract with you for particular sure verse and i don't the qualifications for the people we're going to need to provide the service and it's belt out and you will as the provider do two things one you have people who are not qualified clearly not qualified or in some cases with false credentials why does that not just simply answer the question because you are in your hypothetical you have paid me nonetheless as that is that correct yes of course that they don't know the truth you dumbass absolutely that is a very different i think that everything that you've written i think leads me to this question is that by not following back the money that shows that it was not material reports to the government misconduct is back in late two thousand and nine by march to do a series of reports over that time at some point between two thousand and nine and march sixth two thousand and twelve when the government puts boots on the ground at the clinic and starts going through the files at some point and i confess the complaint is not crystal clear as to when the government you know acquired but certainly no later than murder charge with march sixth of two thousand and twelve and they show up and start going to the  years she was alleged to have taken the board exam twenty years ago and failed that but she had been a practicing licensed physician the entire time the psychologist is a different issue but the psych but she still was not she just factually i'd like to understand something you say that they knew after two thousand and nine but you also said the government state did not put boots on the ground check this out until two thousand and twelve so why shouldn't that interim period as so often happens in regulatory matters and matters like this time goes by and the other side of the government is paying the claims which you're putting that so important because when the government finally got its act together and when and look that when they brought in the remedial actions which would tend to say at least to me that they thought that this material in ways that a statute was not designed to have them change what's the answer to that to his or her first there is no such thing as other reasons for payment and i just want to get that this is a this is sort of a premise that runs throughout  made clear that there needs to be something more than simply condition of payment and repeatedly during the regulations so that everything you're saying makes it sound conclusive just like everything they were saying made it sound like it's not all that important and instead we're stuck with one says it's a very strong evidence of something if there is an allegation that breaks that inference that despite the time pain you give you some examples of what those might be if there's an allegation that breaks that inference that that it must not be material to somewhere in between the regulations are very clear as to what the service is that supposed to be provided and it's clear at least from the peace stage that what you provided was not what you contract to provide so why is actual payment decision is strong evidence i don't think it's permissible then for the government to say well actually provide strong evidence of not materiality one explain away by saying we were counting on over the years to sing for knowledge and trying to speculate as to what's in the minds of a hypothetical reasonable person and that's where i think a lot of the arguments have been were directed earlier where we're trying to figure out who will be have gone how do we go about that with these factors i think are about you know how important is i diagnosis ok so that there's not a sense of actual knowledge no one takes into account the consideration of well another branch of the government this computer doesn't know whether another branch of the government knows what to do there is no real payment decision thank you very much we'll do the best we can with