CHAPTER 22. PROVIDER SANCTIONS

IC 12-15-22
    Chapter 22. Provider Sanctions

IC 12-15-22-1
Denial of payment; rejection of participation application; provideragreement termination; civil penalty; interest charges
    Sec. 1. If after investigation the office determines that a providerhas violated a Medicaid statute or rule adopted under a Medicaidstatute, the office may impose at least one (1) of the followingsanctions:
        (1) Denial of payment to the provider for Medicaid servicesprovided during a specified time.
        (2) Rejection of a prospective provider's application forparticipation in the Medicaid program.
        (3) Termination of a provider agreement permitting a provider'sparticipation in the Medicaid program.
        (4) Assessment of a civil penalty against the provider in anamount not to exceed three (3) times the amount paid to theprovider in excess of the amount that was legally due.
        (5) Assessment of an interest charge, at a rate not to exceed therate established by IC 24-4.6-1-101(2) for judgments on money,on the amount paid to the provider in excess of the amount thatwas legally due. The interest charge accrues from the date ofthe overpayment to the provider.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-1.5
Ineligibility after conviction
    Sec. 1.5. In addition to any sanction imposed on a provider undersection 1 of this chapter, a provider convicted of an offense underIC 35-43-5-7.1 is ineligible to participate in the Medicaid programfor ten (10) years after the conviction.
As added by P.L.46-1995, SEC.40.

IC 12-15-22-2
Administrative appeals; rules
    Sec. 2. A provider may appeal a sanction under section 1 of thischapter under rules concerning appeal that are adopted by thesecretary under IC 4-22-2.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-3
Judicial review
    Sec. 3. After exhausting all administrative remedies, a providermay obtain judicial review of a sanction under IC 4-21.5-5.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-4
Denial of payment or termination of provider agreement;obligation of provider to inform individual services recipients    Sec. 4. A final directive made by the office that:
        (1) denies payment to a provider for medical services providedduring a specified period of time; or
        (2) terminates a provider agreement permitting a provider'sparticipation in the Medicaid program;
must direct the provider to inform each eligible individual recipientof services, before services are provided, that the office or theoffice's contractor under IC 12-15-30 will not pay for those servicesif provided.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-5
Denial of payment, rejection of participation application orprovider agreement termination; time to correct deficiencies
    Sec. 5. Subject to section 6 of this chapter, a final directive:
        (1) denying payment to a provider;
        (2) rejecting a prospective provider's application forparticipation in the Medicaid program; or
        (3) terminating a provider agreement permitting a provider'sparticipation in the Medicaid program;
must be for a sufficient time, in the opinion of the administrator, toallow for the correction of all deficiencies or to prevent furtherabuses.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-6
Eligibility; repayment of excess payments; payment of penalties
    Sec. 6. A provider may not be declared to be eligible until theoffice has received the following:
        (1) Full repayment of the amount paid to the provider in excessof the proper and legal amount due, including any interestcharge assessed by the office.
        (2) Full payment of a civil penalty assessed under section 1(4)of this chapter.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-7
Provider subjected to sanction; agreement as provided inIC 12-15-11
    Sec. 7. Except as provided in section 8 of this chapter, a providerwho has been subjected to a sanction under section 1 of this chaptermay file an agreement as provided in IC 12-15-11.
As added by P.L.2-1992, SEC.9.

IC 12-15-22-8
Eligibility to submit Medicaid claims; criminal convictions;repeated imposition of sanctions
    Sec. 8. A provider who:
        (1) has been convicted of a crime relating to the provision ofservices under this chapter; or        (2) has been subjected to a sanction under section 1 of thischapter on three (3) separate occasions by directive of theadministrator;
is ineligible to submit claims for Medicaid.
As added by P.L.2-1992, SEC.9.