§ 40-8.2-21 - Suspension of payments to a provider. - Rhode Island Statutes

SECTION 40-8.2-21

   § 40-8.2-21  Suspension of payments to aprovider. – (a) The Rhode Island Medicaid program may issue a suspension of payments orderif:

   (1) The provider does not meet certification requirements ofthe Rhode Island Medicaid program; or

   (2) The Rhode Island Medicaid program has been unable tocollect (or make satisfactory arrangements for the collection of  )amounts due on account of overpayments to any provider; or

   (3) The Rhode Island Medicaid program and/or the Medicaidfraud control unit of the attorney general's office has been unable to obtain,from a provider, the data and information necessary to enable it to determinethe existence or amount (if any) of the overpayments made to a provider; or

   (4) The Medicaid fund control unit of the attorney general'soffice has been denied reasonable access to information by a provider whichpertains to a patient or resident of a long term residential care facility orto a former patient or resident of a long term residential care facility; or

   (5) The Rhode Island Medicaid program and/or the Medicaidfraud control unit of the attorney general's office has been denied reasonableaccess to data and information by the provider for the purpose of conductingactivities as described in § 1903(g) of the Social Security Act, 42 U.S.C.§ 1396b(g); or

   (6) The Rhode Island Medicaid program has been presented withreliable evidence that the provider has engaged in fraud or willfulmisrepresentation under the Medicaid program.

   (b) Any such order of the Rhode Island Medicaid program maycease to be effective at such time as the program is satisfied that theprovider is participating in substantial negotiations which seek to remedy theconditions which gave rise to its order of suspension of payments, or thatamounts are no longer due from the provider or that a satisfactory arrangementhas been made for the payment of the provider or that a satisfactoryarrangement has been made for the payment by the provider of any such amounts.