D.C. Mun. Regs. tit. 29, r. 29-8903

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

Rule 29-8903 - PROGRAM INTEGRITY

8903.1

An eligible provider shall retain documentation that verifies its eligibility for MEIP for a minimum of ten (10) years and cooperate with DHCF and any other duly authorized agent of a governmental agency seeking to audit compliance with MEIP requirements.

8903.2

An eligible provider's cooperation shall include, but is not limited to, the following:

(a) Making available to DHCF, or its designee, upon request, all necessary and complete records and other documentation for audit purposes as specified in the request;

(b) Permitting DHCF, or its designee, to audit, inspect, examine, excerpt, copy and/or transcribe the records related to this incentive program; and

(c) Permitting DHCF, or its designee, to access its premises to inspect and monitor its compliance with program requirements.

8903.3

DHCF shall prevent fraud, waste, and abuse by employing the following actions:

(a) Conduct a full investigation or refer the case to the State Medicaid fraud control unit upon suspicion or detection of fraud or abuse by an eligible provider;

(b) Refer the case to the appropriate law enforcement agency upon suspicion or detection of fraud by a beneficiary; and

(c) Comply with all other laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to applicable provisions of federal criminal law, the False Claims Act (31 U.S.C. § 3729et seq.), the Anti-Kickback Statute (42 U.S.C. § 1320a-7b) , § 1128 B(b) of the Social Security Act, and 42 C.F.R.§ 495.368.

8903.4

DHCF may take the following actions with respect to an eligible provider found deficient or in violation of this rule:

(a) Suspend an incentive payment until the eligible provider has removed the deficiency to the satisfaction of DHCF;

(b) Require full repayment of all or a portion of an incentive payment; or

(c) Terminate the eligible provider's MEIP participation.

8903.5

DHCF shall issue a written notice when any action is taken pursuant to Subsection 8903.3 in accordance with the requirements set forth in Chapter 13 of Title 29 DCMR.

D.C. Mun. Regs. tit. 29, r. 29-8903

Final Rulemaking published at 61 DCR 237 (January 10, 2014)

Authority: An Act to enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat.744; D.C. Official Code § 1-307.02 (2013 Supp.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).