D.C. Mun. Regs. tit. 29, r. 29-1302

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-1302 - TERMINATION OF MEDICAID PROVIDER AGREEMENT

1302.1

The Director may terminate a provider agreement under Medicaid if he or she determines that at any time prior to or after the effective date of these rules, the provider has done any one (1) of the following:

(a) He or she engaged in any activity listed in § 1301 regarding fraud or abuse;

(b) Is not currently licensed and registered and/or certified as required by the law of the jurisdiction in which he or she practices;

(c) Did not comply substantially with the provisions of Title XIX or with provisions of the provider agreement and pertinent District laws and regulations;

(d) Failed to furnish requested information that the Director has found necessary for a determination as to whether payments are or were due under Medicaid and the amounts due;

(e) Refused to permit a requested examination of its fiscal or other records by or on behalf of DHS or HCFA, as necessary, for verification of information furnished as a basis for payment under Medicare;

(f) Had disciplinary action against him or her entered on the records of the State or District licensing or certifying agency;

(g) Had his or her controlled drug licenses withdrawn;

(h) Falsified information related to a request for payment;

(i) Repeatedly claimed District Medicaid reimbursement for services provided to individuals who have borrowed or stolen District of Columbia Medicaid Identification Cards as proof of eligibility; or

(j) Has been suspended or excluded from Medicare or convicted of a program-related offense, in a Federal, State, or District of Columbia Court.

D.C. Mun. Regs. tit. 29, r. 29-1302

Final Rulemaking published at 31 DCR 3870 (August 3, 1984); as amended by Emergency Rulemaking at 51 DCR 3742 (April 9, 2004) [EXPIRED]