Or. Admin. Code § 333-046-0090

Current through Register Vol. 63, No. 12, December 1, 2024

Section 333-046-0090 - Provider Sanctions

The Authority may terminate a clinic's or prescriber's participation in the VFC program based on the following:

(1) Violation of the terms of the VFC Program Agreement.

(2) Conviction of fraud related to any federal, state, or locally financed health care program or commission of an act that is subject to criminal or civil penalties under Medicaid statutes.

(3) Conviction of interference with the investigation of health care fraud.

(4) An action by a state licensing authority relating to a prescriber's professional competence, professional conduct, or financial integrity, that results in the prescriber either:

(a) Having his or her license suspended or revoked; or

(b) Surrendering the license while a formal disciplinary proceeding was pending before a licensing authority.

(5) Suspension or exclusion from participation in a federal or state-administered health care program for reasons related to professional competence, professional performance, or other reason.

(6) Improper billing practices, including billing for the cost of state-supplied vaccines, excessive charges or unnecessary vaccination visits.

(7) Failure to correct deficiencies in operations after receiving written notice of the deficiencies from the Authority.

(8) The Authority shall consider the following factors in determining the sanctions to be imposed (this list includes but is not limited to these factors):

(a) Seriousness of the offenses;

(b) Extent of violations by the prescriber;

(c) History of prior violations by the prescriber;

(d) Prior imposition of sanctions;

(e) Prior education provided by the Authority; and

(f) Prescriber willingness to comply with VFC rules and procedures.

Or. Admin. Code § 333-046-0090

PH 39-2016, f. & cert. ef. 12/22/2016

Stat. Auth.: ORS 413.042, 431.250

Stats. Implemented: ORS 413.042, 431.250