We have incurred
indebtedness, and we may incur additional indebtedness, which could
adversely affect our business.
As of December 31, 2022, we had an outstanding balance of $10.0
million under our Loan and Security Agreement with Hercules
Capital, Inc., or the Loan Agreement. Our indebtedness could have
important consequences to our stockholders. For example, it:
●increases our vulnerability to adverse general economic and
industry conditions;
●limits our flexibility in planning for, or reacting to, changes in
our business or the industries in which we operate by restricting
our ability to make acquisitions, investments or divestments, or
take other corporate actions quickly; and
●limits our ability to obtain additional financing or refinancing
in the future for working capital, clinical trials, research and
development, or other purposes.
Any of the above-listed factors could materially adversely affect
our business, financial condition, results of operations, and cash
flows. The Loan Agreement also contains certain financial and other
covenants, including limitations on, among other things, additional
indebtedness, out licensing, paying dividends in certain
circumstances, and making certain acquisitions and investments. Any
failure to comply with the terms, covenants and conditions of the
Loan Agreement may limit our ability to draw upon additional
tranches of term loans and may result in an event of default under
such agreement, which could have a material adverse effect on our
business, financial condition, and results of operations.
We are subject to
various foreign, federal, and state healthcare and privacy laws and
regulations, and our failure to comply with these laws and
regulations could harm our results of operations and financial
condition.
Our business operations and current and future arrangements with
investigators, healthcare professionals, consultants, third-party
payors, and customers expose us to broadly applicable foreign,
federal and state fraud and abuse, and other healthcare and privacy
laws and regulations. These laws may constrain the business or
financial arrangements and relationships through which we conduct
our operations, including how we research, market, sell, and
distribute any products for which we obtain marketing approval.
Such laws include:
●the federal Anti-Kickback Statute, which prohibits, among other
things, persons, or entities from knowingly and willfully
soliciting, offering, receiving, or providing any remuneration
(including any kickback, bribe, or certain rebates), directly or
indirectly, overtly or covertly, in cash or in-kind, in return for,
either the referral of an individual or the purchase, lease, or
order, or arranging for or recommending the purchase, lease, or
order of any good, facility, item or service, for which payment may
be made, in whole or in part, under a federal healthcare program
such as Medicare and Medicaid. A person or entity does not need to
have actual knowledge of the federal Anti-Kickback Statute or
specific intent to violate it in order to have committed a
violation. In addition, the government may assert that a claim
including items or services resulting from a violation of the
federal Anti-Kickback Statute constitutes a false or fraudulent
claim for purposes of the civil False Claims Act;
●the federal false claims and civil monetary penalties laws,
including the civil False Claims Act, which prohibits, among other
things, individuals or entities from knowingly presenting, or
causing to be presented, to the federal government, claims for
payment or approval that are false or fraudulent, knowingly making,
using or causing to be made or used, a false record or statement
material to a false or fraudulent claim, or from knowingly making
or causing to be made a false statement to avoid, decrease, or
conceal an obligation to pay money to the federal government;