OAR 309-015-0052
Provider Sanctions

(1)

Basis for sanctioning. The Division will follow the Division of Medical Assistance Program rules OAR 410-120-0000 (Acronyms and Definitions) through 410-120-1980 (Requests for Information and Public Records) and Section 1902 of the Social Security Act for provider sanctions. The basis for sanctioning will include:

(a)

Criminal convictions;

(b)

Exclusion, by the Secretary of Health and Human Services, from participation in the Medicare program;

(c)

Not meeting the federal regulatory requirements for services in an institution for mental diseases or a psychiatric hospital as set forth at 42 CFR 435.1009 and 42 CFR 441, Subparts C and D;

(d)

Having deficiencies which immediately jeopardize, or may jeopardize, the health and safety of patients;

(e)

Abuse and misutilization, as described in OAR 410-120-0000 (Acronyms and Definitions) through 410-120-1980 (Requests for Information and Public Records);

(f)

Termination:

(A)

From another governmental health/medical program;

(B)

For failure to repay identified overpayments; or

(C)

Due to commission, by a provider formerly suspended by the Division, of additional abuse or misutilization.

(2)

Sanctions. The following sanctions may be imposed on a provider by the Division, based on grounds specified in this rule and may include:

(a)

Termination from participation in Oregon’s Medical Assistance Program and possible initiation of appropriate civil or criminal proceedings;

(b)

Suspension from participation in Oregon’s Medicaid Assistance Program;

(c)

Suspension or withholding of payments to a provider;

(d)

Required attendance at provider education sessions.

(3)

Notice to providers. The Division will notify a deficient provider of action the Division plans to take at least 15 days prior to commencement of the action; the notification will include an explanation of the provider’s right to appeal the proposed action (see OAR 309-015-0055 (Appeals)).

Source: Rule 309-015-0052 — Provider Sanctions, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=309-015-0052.

Last Updated

Jun. 8, 2021

Rule 309-015-0052’s source at or​.us