^1. Genesis certifies that, as the Appointed Representative, the healthcare organization has not been disqualified, suspended, or prohibited from practice before the Department of Health and Human Services (HHS) and has not been disqualified from acting as a party’s representative. Genesis, as the Appointed Representative of beneficiaries, waives the right to charge and collect a fee for representing the beneficiary before the Secretary of HHS. Genesis, as the Appointed Representative, also waives the right to collect payment from the beneficiary for items or services on appeal if a determination of liability under §1879(a)(2) of the Act is at issue.