CHAPTER 6. PROVIDER SANCTIONS, THEFT, KICKBACKS, AND BRIBES
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 has
violated this article or rule adopted under this article, the office may
impose at least one (1) of the following sanctions:
(1) Deny payment to the provider for program services provided
during a specified time.
(2) Reject a prospective provider's application for participation
in the program.
(3) Terminate a provider agreement allowing a provider's
participation in the program.
(4) Assess a civil penalty against the provider in an amount not
to exceed three (3) times the amount paid to the provider that
exceeds the amount that was legally due.
(5) Assess 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 that exceeds the amount that
was legally due. The interest charge accrues from the date of
the 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 under
section 2 of this chapter, a provider convicted of an offense under
IC 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 section
2 of this chapter under rules concerning Medicaid provider appeals
that 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 provider
may 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 not
pay
Sec. 6. A final directive made by the office that:
(1) denies payment to a provider for medical services provided
during a specified period; or
(2) terminates a provider agreement permitting a provider's
participation 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 those
services 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 for
participation in the program; or
(3) terminating a provider agreement allowing a provider's
participation in the program;
must be for a sufficient time, in the opinion of the office, to allow for
the 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 provider
sanctioned under section 2 of this chapter may not be declared
reinstated as a provider under this article 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 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 provider
sanctioned under section 2 of this chapter may file an agreement as
provided 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 services
under this chapter; or
(2) subjected to a sanction under section 2 of this chapter on
three (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 or
other 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, that
the person or provider intended to deprive the state of a part of the
value 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 individual
for which payment is or may be made under this chapter and who
knowingly or intentionally solicits, offers, or receives a:
(1) kickback or bribe in connection with the furnishing of the
items or services or the making or receipt of the payment; or
(2) rebate of a fee or charge for referring the individual to
another person for the furnishing of items or services;
commits a Class A misdemeanor.
As added by P.L.273-1999, SEC.177.