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Part 9505.2236
9505.2236 RESTRICTION OF PROVIDER OR VENDOR PARTICIPATION.
Subpart 1.
Effect of restriction on a provider or vendor.
The provider agreement of a vendor who is restricted from participation shall be amended by the restriction specified in the notice of action to the vendor provided under part 9505.2230. A vendor who is restricted from participation shall not submit a claim for payment under a program for services or charges specified in the notice of action, 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 otherwise eligible for payment and provided before the restriction. No payments shall be made to a vendor, either directly or indirectly, for restricted services or charges specified in the notice of action.
Subp. 2.
Reinstatement of restricted provider or vendor.
A vendor who is restricted from participation is eligible to apply for reinstatement as an unrestricted provider or vendor at the end of the period of restriction. The department shall review a vendor's application to determine whether the vendor is qualified to participate without restrictions 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 restricted vendor's claims.
A provider shall not submit a claim for a health service furnished under a program by a vendor who is restricted from furnishing the health service or submitting a charge or claim, unless the health service was provided before the vendor's restriction. If a provider receives payment for a health service furnished under a program by a vendor restricted from furnishing the health service or submitting a charge or claim, 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 restriction.
History:
15 SR 2563; 19 SR 1898
Published Electronically:
August 12, 2008
Official Publication of the State of Minnesota
Revisor of Statutes