(a) The Department may suspend providers under the following conditions: - (i) Suspected fraud, theft or abuse of services;
- (ii) Situations that pose a threat to the health, safety, or welfare of clients and/or the general public;
- (iii) Suspension or termination of state licensure or any certification required to provide services;
- (iv) Lack of, or repeated failure to provide documentation of Medicaid services;
- (v) Inability to collect overpayments;
- (vi) Failure to comply with the provisions of the provider agreement;
- (vii) Failure to maintain current contact information as described in Chapter 3; or
- (viii) Violation of Medicaid, Department, or other state or federal statute, rule, or law relating to provisions of services.
(b) Effect of suspension. - (i) A suspension under this section shall be the same and shall run contemporaneously with the period of the provider's suspension from a licensing entity, Medicare, or the period of voluntary non-participation from either, if these are a requirement of Medicaid enrollment.
- (ii) A suspended provider shall not submit any claims, either personally or through a third party payer, clinic, group or other association, for any services provided after the effective date of the suspension;
- (iii) No clinic, group, corporation, professional association or other organization shall submit any claim for services provided by an individual provider within such organization after the effective date of the individual provider's suspension; and
- (iv) The Department shall not pay any claims submitted by a provider for services provided to a client during any period of suspension.
(c) The Department may suspend any and all provider numbers that have the same tax identification number as the provider number that has been suspended.
(d) Reinstatement. No provider that has been suspended shall be reinstated as a Medicaid provider until: - (i) The Department has been reimbursed for all overpayments; and
- (ii) The Department is satisfied that sufficient safeguards have been installed to insure that the fraud, theft, or abuse of services, or other factors which led to the suspension, will not recur.
(e) No obligation to reinstate. The Department shall not be obligated to reinstate a suspended provider prior to the end of the period of suspension even if the requirements of subsection 16(d) of this Chapter are satisfied.
048-16 Wyo. Code R. § 16-16