Section 75-03-23-08.1 - Sanctions and termination of qualified service providers1. The department may impose sanctions against a qualified service provider for any of the reasons listed under section 75-02-05-05 or subdivisions b though g of subsection 4. Prior to imposing sanctions, the department may require provider education or a business integrity agreement.2. The department may consider the following in determining the sanction to be imposed:a. Seriousness of the qualified service provider's offense.b. Extent of the qualified service provider's violations.c. Qualified service provider's history of prior violations.d. Prior imposition of sanctions against the qualified service provider.e. Prior provision of information and training to the qualified service provider.f. Qualified service provider's agreement to make restitution to the department.g. Actions taken or recommended by peer groups or licensing boards.h. Access to care for eligible individuals.i. Qualified service provider's self-disclosure or self-audit discoveries.j. Qualified service provider's willingness to enter a business integrity agreement.3. The department may impose any of the sanctions listed in subsections 8 or 9 of section 75-02-05-07.4. The department may terminate a qualified service provider if:a. The qualified service provider voluntarily withdraws from participation as a qualified service provider.b. The qualified service provider is not in compliance with applicable state laws, state regulations, or program issuances governing providers.c. The qualified service provider is not in compliance with the terms set forth in the application or provider agreement.d. The qualified service provider is not in compliance with the provider certification terms on the claims submitted for payment.e. The qualified service provider has assigned or otherwise transferred the right to payment of a program claim, except as provided in 42 U.S.C. 1396a(a)(32).f. The qualified service provider has demonstrated a pattern of submitting inaccurate billings or cost reports.g. The qualified service provider has demonstrated a pattern of submitting billings for services not covered under department programs.h. The qualified service provider has been debarred or the provider's license or certificate to practice in the provider's profession or to conduct business has been suspended or terminated.i. The qualified service provider has delivered goods, supplies, or services that are of an inferior quality or are harmful to individuals.j. The qualified service provider has been convicted of an offense determined by the department to have a direct bearing upon the provider's ability to be enrolled as a qualified service provider, or the department determines, following conviction of any other offense, the provider is not sufficiently rehabilitated.k. The qualified service provider is currently excluded from participation in Medicare, Medicaid, or any other federal health care program.l. The qualified service provider has not provided sufficient evidence to the department, after obtaining a formal evaluation under subsection 3 of section 75-03-23-07 that the provider is physically, cognitively, socially, or emotionally capable of providing the care.m. The qualified service provider refuses to repay or make arrangements for the repayment of identified overpayments or otherwise erroneous payments.n. There has been no billing activity within the twelve months since the qualified service provider's enrollment or most recent re-enrollment date.o. The qualified service provider has demonstrated a pattern of absenteeism by failing to provide care they have been authorized and agreed to provide per subsection 11 of section 75-03-23-07 to an eligible individual.N.D. Admin Code 75-03-23-08.1
Adopted byAdministrative Rules Supplement 375, January 2020, effective1/1/2020Amended by Administrative Rules Supplement 2021-383, January 2022, effective 1/1/2022.Amended by Administrative Rules Supplement 2022-386, October 2022, effective 10/1/2022.Amended by Administrative Rules Supplement 2023-391, January 2024, effective 1/1/2024.General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5)