Sec. 10.09.29.09. Cause for Suspension or Removal and Imposition of Sanctions

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 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) Removal from the Program;

(4) 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 will take similar action.

C. A provider who voluntarily withdraws from the Program or is removed or suspended from the Program according to this regulation shall notify recipients that it no longer honors Medical Assistance cards before it renders additional services.

D. The Department shall give to the provider reasonable written notice of the Department’s intention to impose sanctions. In the notice, the Department shall:

(1) Establish the:

(a) Effective date of the proposed action; and

(b) Reasons for the proposed action; and

(2) Advise the provider of the right to appeal.