Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.
Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
A.
If the Department determines that a provider, any agent or employee of the provider, or any person with an ownership interest in the provider or related party of the provider has failed to comply with applicable federal or State laws or regulations, the Department may initiate one or more of the following actions against the responsible party:
(1)
Suspension from the Program;
(2)
Withholding of payment by the Program;
(3)
Recovery of an overpayment;
(4)
Removal from the Program; and
(5)
Disqualification from future participation in the Program, either as a provider or as a person providing services for which Program payment will be claimed.
B.
If the Secretary of Health and Human Services suspends or removes a provider from participation in Medicare, the Department shall take similar action.
C.
The Department may report to the federal Secretary of Health and Human services any providers removed from participation with the Program for failure to comply with applicable federal or State laws and regulations in accordance with 42 CFR §455.416.
D.
The Department shall give the provider reasonable notice of its intention to impose sanctions. In the written notice, the Department shall establish the effective date and the reasons for the proposed action, and advise the provider of the right to appeal.
E.
A provider who voluntarily withdraws from the Program, or is removed or suspended from the Program according to this regulation, shall notify participants, before rendering additional services, that the provider no longer honors Medical Assistance cards.