IC 12-15-22-1 Denial of payment; rejection of participation application; provider
agreement termination; civil penalty; interest charges
Sec. 1. If after investigation the office determines that a provider
has violated a Medicaid statute or rule adopted under a Medicaid
statute, the office may impose at least one (1) of the following
sanctions:
(1) Denial of payment to the provider for Medicaid services
provided during a specified time.
(2) Rejection of a prospective provider's application for
participation in the Medicaid program.
(3) Termination of a provider agreement permitting a provider's
participation in the Medicaid program.
(4) Assessment of a civil penalty against the provider in an
amount not to exceed three (3) times the amount paid to the
provider in excess of the amount that was legally due.
(5) Assessment of an interest charge, at a rate not to exceed the
rate 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 that
was legally due. The interest charge accrues from the date of
the 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 under
section 1 of this chapter, a provider convicted of an offense under
IC 35-43-5-7.1 is ineligible to participate in the Medicaid program
for 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 this
chapter under rules concerning appeal that are adopted by the
secretary 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 provider
may 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 provided
during a specified period of time; or
(2) terminates a provider agreement permitting a provider's
participation in the Medicaid program;
must direct the provider to inform each eligible individual recipient
of services, before services are provided, that the office or the
office's contractor under IC 12-15-30 will not pay for those services
if provided. As added by P.L.2-1992, SEC.9.
IC 12-15-22-5 Denial of payment, rejection of participation application or
provider 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 for
participation in the Medicaid program; or
(3) terminating a provider agreement permitting a provider's
participation in the Medicaid program;
must be for a sufficient time, in the opinion of the administrator, to
allow for the correction of all deficiencies or to prevent further
abuses. 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 the
office has received the following:
(1) Full repayment of the amount paid to the provider in excess
of the proper and legal amount due, including any interest
charge 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 in
IC 12-15-11
Sec. 7. Except as provided in section 8 of this chapter, a provider
who has been subjected to a sanction under section 1 of this chapter
may 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 of
services under this chapter; or
(2) has been subjected to a sanction under section 1 of this
chapter on three (3) separate occasions by directive of the
administrator;
is ineligible to submit claims for Medicaid. As added by P.L.2-1992, SEC.9.
IC 12-15-22-1 Denial of payment; rejection of participation application; provider
agreement termination; civil penalty; interest charges
Sec. 1. If after investigation the office determines that a provider
has violated a Medicaid statute or rule adopted under a Medicaid
statute, the office may impose at least one (1) of the following
sanctions:
(1) Denial of payment to the provider for Medicaid services
provided during a specified time.
(2) Rejection of a prospective provider's application for
participation in the Medicaid program.
(3) Termination of a provider agreement permitting a provider's
participation in the Medicaid program.
(4) Assessment of a civil penalty against the provider in an
amount not to exceed three (3) times the amount paid to the
provider in excess of the amount that was legally due.
(5) Assessment of an interest charge, at a rate not to exceed the
rate 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 that
was legally due. The interest charge accrues from the date of
the 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 under
section 1 of this chapter, a provider convicted of an offense under
IC 35-43-5-7.1 is ineligible to participate in the Medicaid program
for 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 this
chapter under rules concerning appeal that are adopted by the
secretary 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 provider
may 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 provided
during a specified period of time; or
(2) terminates a provider agreement permitting a provider's
participation in the Medicaid program;
must direct the provider to inform each eligible individual recipient
of services, before services are provided, that the office or the
office's contractor under IC 12-15-30 will not pay for those services
if provided. As added by P.L.2-1992, SEC.9.
IC 12-15-22-5 Denial of payment, rejection of participation application or
provider 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 for
participation in the Medicaid program; or
(3) terminating a provider agreement permitting a provider's
participation in the Medicaid program;
must be for a sufficient time, in the opinion of the administrator, to
allow for the correction of all deficiencies or to prevent further
abuses. 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 the
office has received the following:
(1) Full repayment of the amount paid to the provider in excess
of the proper and legal amount due, including any interest
charge 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 in
IC 12-15-11
Sec. 7. Except as provided in section 8 of this chapter, a provider
who has been subjected to a sanction under section 1 of this chapter
may 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 of
services under this chapter; or
(2) has been subjected to a sanction under section 1 of this
chapter on three (3) separate occasions by directive of the
administrator;
is ineligible to submit claims for Medicaid. As added by P.L.2-1992, SEC.9.
IC 12-15-22-1 Denial of payment; rejection of participation application; provider
agreement termination; civil penalty; interest charges
Sec. 1. If after investigation the office determines that a provider
has violated a Medicaid statute or rule adopted under a Medicaid
statute, the office may impose at least one (1) of the following
sanctions:
(1) Denial of payment to the provider for Medicaid services
provided during a specified time.
(2) Rejection of a prospective provider's application for
participation in the Medicaid program.
(3) Termination of a provider agreement permitting a provider's
participation in the Medicaid program.
(4) Assessment of a civil penalty against the provider in an
amount not to exceed three (3) times the amount paid to the
provider in excess of the amount that was legally due.
(5) Assessment of an interest charge, at a rate not to exceed the
rate 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 that
was legally due. The interest charge accrues from the date of
the 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 under
section 1 of this chapter, a provider convicted of an offense under
IC 35-43-5-7.1 is ineligible to participate in the Medicaid program
for 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 this
chapter under rules concerning appeal that are adopted by the
secretary 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 provider
may 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 provided
during a specified period of time; or
(2) terminates a provider agreement permitting a provider's
participation in the Medicaid program;
must direct the provider to inform each eligible individual recipient
of services, before services are provided, that the office or the
office's contractor under IC 12-15-30 will not pay for those services
if provided. As added by P.L.2-1992, SEC.9.
IC 12-15-22-5 Denial of payment, rejection of participation application or
provider 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 for
participation in the Medicaid program; or
(3) terminating a provider agreement permitting a provider's
participation in the Medicaid program;
must be for a sufficient time, in the opinion of the administrator, to
allow for the correction of all deficiencies or to prevent further
abuses. 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 the
office has received the following:
(1) Full repayment of the amount paid to the provider in excess
of the proper and legal amount due, including any interest
charge 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 in
IC 12-15-11
Sec. 7. Except as provided in section 8 of this chapter, a provider
who has been subjected to a sanction under section 1 of this chapter
may 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 of
services under this chapter; or
(2) has been subjected to a sanction under section 1 of this
chapter on three (3) separate occasions by directive of the
administrator;
is ineligible to submit claims for Medicaid. As added by P.L.2-1992, SEC.9.
