Or. Admin. R. 333-004-3200

Current through Register Vol. 63, No. 8, August 1, 2024

Section 333-004-3200 - Grounds for Agency Sanctions; Sanctions

(1) The following may result in the imposition of a sanction against an agency:

(a) Interference with the investigation of health care fraud;

(b) Conviction for unlawfully manufacturing, distributing, prescribing, or dispensing a controlled substance;

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

(A) Having their license suspended or revoked; or

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

(d) 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;

(e) Threatening, intimidating or harassing clients or their relatives in an attempt to influence payment rates or affect the outcome of disputes between the provider and the RH Program;

(f) Participation in collusion that resulted in an inappropriate money flow between the parties involved, for example, referring clients unnecessarily to another provider;

(g) For claims paid using CCare funds, any sanctions outlined in OAR 410-120-1400 (HSD Medicaid Programs, General Administrative Rules);

(h) Unauthorized or unlawful disclosure of client information; and

(i) Failure to comply with these rules.

(2) The RH Program shall consider the following factors in determining whether to issue a sanction and the sanction to be imposed:

(a) Nature of the violation or offense;

(b) Extent of the violations by the agency;

(c) History of prior violations by the agency;

(d) Prior imposition of sanctions;

(e) Prior notification of compliance findings; and

(f) Cooperation with an investigation.

(3) Sanctions may include one or more of the following:

(a) Termination of certification;

(b) Imposition of a Corrective Action Plan;

(c) A requirement to attend provider education sessions at the expense of the sanctioned agency;

(d) A requirement that payment for certain services are made only after the RH Program has reviewed documentation supporting the services; and

(e) For claims paid using CCare funds, any action authorized under OAR 410-120-1460 (HSD Provider Sanctions).

Or. Admin. R. 333-004-3200

PH 84-2020, adopt filed 12/18/2020, effective 1/1/2021; PH 202-2022, amend filed 10/27/2022, effective 10/27/2022

Statutory/Other Authority: ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149 & OL 2022, ch. 45, sec. 10

Statutes/Other Implemented: ORS 414.432, ORS 431.147, ORS 413.032 & OL 2022, ch. 45, sec. 10