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Part 9505.2235
9505.2235 SUSPENSION OR TERMINATION OF VENDOR PARTICIPATION.
Subpart 1.
Effect of suspension or termination.
The provider agreement of a vendor who is under suspension or terminated from participation shall be void from the date of the suspension or termination. A suspension or termination from medical assistance does not mean suspension or termination from another program unless the suspension or termination is extended to that program. The vendor who is under suspension or terminated from participation shall not submit a claim for payment under a program, either through a claim as an individual or through a claim submitted by a clinic, group, corporation, or professional association except in the case of claims for payment for health services provided before the suspension or termination from participation. No payments shall be made to a vendor, either directly or indirectly, for services provided under a program from which the vendor had been suspended or terminated.
Subp. 2.
Reinstatement of vendor.
A vendor who is under suspension or terminated from participation is eligible to apply for reinstatement as a provider or vendor at the end of the period of suspension or when the basis for termination no longer exists. The department shall review a vendor's application to determine whether the vendor is qualified to participate as specified by the participation requirements of part 9505.0195 and Code of Federal Regulations, title 42, section 1002.215.
Subp. 3.
Prohibited submission of vendor's claims.
A provider shall not submit a claim for a health service under a program provided by a vendor who is under suspension or terminated from participation unless the health service was provided before the vendor's suspension or termination. If a provider receives payment under a program for a health service provided by a vendor after the vendor's suspension or termination from participation, the department shall recover the amount of the payment and may impose administrative sanctions against the provider if the commissioner determines that the provider knew or had reason to know of the suspension or termination.
History:
15 SR 2563; 19 SR 1898
Published Electronically:
August 12, 2008
Official Publication of the State of Minnesota
Revisor of Statutes