IC 12-17.6-6
    Chapter 6. Provider Sanctions, Theft, Kickbacks, and Bribes

IC 12-17.6-6-1
Applicability of chapter
    Sec. 1. This chapter does not apply until January 1, 2000.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-2
Provider sanctions
    Sec. 2. If after investigation the office finds that a provider hasviolated this article or rule adopted under this article, the office mayimpose at least one (1) of the following sanctions:
        (1) Deny payment to the provider for program services providedduring a specified time.
        (2) Reject a prospective provider's application for participationin the program.
        (3) Terminate a provider agreement allowing a provider'sparticipation in the program.
        (4) Assess a civil penalty against the provider in an amount notto exceed three (3) times the amount paid to the provider thatexceeds the amount that was legally due.
        (5) Assess an interest charge, at a rate not to exceed the rateestablished by IC 24-4.6-1-101(2) for judgments on money, onthe amount paid to the provider that exceeds the amount thatwas legally due. The interest charge accrues from the date ofthe overpayment to the provider.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-3
Ineligibility to participate in program
    Sec. 3. In addition to any sanction imposed on a provider undersection 2 of this chapter, a provider convicted of an offense underIC 35-43-5-7.2 is ineligible to participate in the program for ten (10)years after the conviction.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-4
Administrative review
    Sec. 4. A provider may appeal a sanction imposed under section2 of this chapter under rules concerning Medicaid provider appealsthat are adopted by the secretary under IC 4-22-2.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-5
Judicial review
    Sec. 5. After exhausting all administrative remedies, a providermay obtain judicial review of a sanction under IC 4-21.5-5.
As added by P.L.273-1999, SEC.177.
IC 12-17.6-6-6
Provider to notify recipients of services for which office will notpay
    Sec. 6. A final directive made by the office that:
        (1) denies payment to a provider for medical services providedduring a specified period; or
        (2) terminates a provider agreement permitting a provider'sparticipation in the program;
must direct the provider to inform each eligible recipient of services,before services are provided, that the office will not pay for thoseservices if provided.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-7
Duration of final directive
    Sec. 7. Subject to section 8 of this chapter, a final directive:
        (1) denying payment to a provider;
        (2) rejecting a prospective provider's application forparticipation in the program; or
        (3) terminating a provider agreement allowing a provider'sparticipation in the program;
must be for a sufficient time, in the opinion of the office, to allow forthe correction of all deficiencies or to prevent further abuses.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-8
Conditions for reinstatement of provider under sanction
    Sec. 8. Except as provided in section 10 of this chapter, a providersanctioned under section 2 of this chapter may not be declaredreinstated as a provider under this article until the office has receivedthe 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 2(4)of this chapter.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-9
Provider filing agreements under sanction
    Sec. 9. Except as provided in section 10 of this chapter, a providersanctioned under section 2 of this chapter may file an agreement asprovided in IC 12-17.6-5.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-10
Ineligibility of provider under sanction to submit claims
    Sec. 10. A provider who has been:
        (1) convicted of a crime relating to the provision of servicesunder this chapter; or        (2) subjected to a sanction under section 2 of this chapter onthree (3) separate occasions by directive of the office;
is ineligible to submit claims for the program.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-11
Prima facie evidence of intent to deprive state of value
    Sec. 11. Evidence that a person or provider received money orother benefits as a result of a violation of:
        (1) a provision of this article; or
        (2) a rule established by the office under this article;
constitutes prima facie evidence, for purposes of IC 35-43-4-2, thatthe person or provider intended to deprive the state of a part of thevalue of the money or benefits.
As added by P.L.273-1999, SEC.177.

IC 12-17.6-6-12
Violations
    Sec. 12. A person who furnishes items or services to an individualfor which payment is or may be made under this chapter and whoknowingly or intentionally solicits, offers, or receives a:
        (1) kickback or bribe in connection with the furnishing of theitems or services or the making or receipt of the payment; or
        (2) rebate of a fee or charge for referring the individual toanother person for the furnishing of items or services;
commits a Class A misdemeanor.
As added by P.L.273-1999, SEC.177.