OAR 333-010-0180
Provider Sanctions

The following are conditions that may result in the imposition of a sanction on a provider.

(1)

Basis for Sanction:

(a)

Conviction of a provider of a felony or misdemeanor related to a crime or violation of Title XVIII, XIX, or XX of the Social Security Act or related state laws (or entered a plea of nolo contendere);

(b)

Conviction of fraud related to any federal, state, or locally financed health care program;

(c)

Conviction of interference with the investigation of health care fraud;

(d)

Conviction of unlawfully manufacturing, distributing, prescribing, or dispensing a controlled substance;

(e)

Failure to comply with the state and federal statutory requirements set forth in OAR 333-010-0165 (Compliance with Federal and State Statutes);

(f)

By actions of any state licensing authority for reasons relating to the provider’s professional competence, professional conduct, or financial integrity, the provider either:

(A)

Had a health care license suspended or revoked, or has otherwise lost such license; or

(B)

Surrendered the license while a formal disciplinary proceeding was pending before a licensing authority.

(g)

Suspension or exclusion from participation in a federal or state health care program for reasons related to professional competence, professional performance, or other reason;

(h)

Improper billing practices, including billing for excessive charges or visits;

(i)

Failure to furnish services as required by law or contract with the Center, if the failure has adversely affected (or has a substantial likelihood of adversely affecting) the client;

(j)

Failure to supply requested information on subcontractors and suppliers of goods or services;

(k)

Failure to supply requested payment information;

(l)

Failure to grant access to facilities or provide records upon request of the Center or a designated Requestor;

(m)

Receiving payments for services provided to persons who were not eligible;

(n)

Establishing multiple claims using procedure codes that overstate or misrepresent the level, amount or type of health care provided;

(o)

Failure to develop, maintain, and retain in accordance with relevant rules and standards adequate clinical or other records that document the medical appropriateness, nature, and extent of the health care provided;

(p)

Failure to develop, maintain, and retain in accordance with relevant rules and standards adequate financial records that document charges incurred by a client and payments received from any source;

(q)

Failure to follow generally accepted accounting principles or accounting standards or cost principles required by federal or state laws, rule, or regulation;

(r)

Submission of claims or written orders contrary to generally accepted standards of medical practice;

(s)

Submission of claims for services that exceed that requested or agreed to by the client or the responsible relative or guardian or requested by another medical practitioner;

(t)

Breach of the terms of the medical services agreement;

(u)

Failure to correct deficiencies in operations after receiving written notice of the deficiencies from the Center;
(v)
Submission of any claim for payment for which payment has already been made by the Center; or

(w)

Provision of or billing for services provided by ineligible or unsupervised staff.

(2)

A provider who has been suspended or terminated from participation in a federal or state medical program, such as Medicare or Medicaid, or whose license to practice has been suspended or revoked by a state licensing board, shall not submit claims for payment, either personally or through claims submitted by any billing provider or other provider, for any services or supplies provided under ScreenWise BCC, except those services provided prior to the date of suspension or termination.

(3)

When the provisions of section (2) of this section are violated, the Center may suspend or terminate the provider who is responsible for the violation.

(4)

Provider sanctions will be imposed at the discretion of the Authority or the administrator of the office whose budget includes payment for the services involved.

Source: Rule 333-010-0180 — Provider Sanctions, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-010-0180.

333‑010‑0000
Cancer Reporting Regulations: Definitions 333‑010‑0020
Cancer Reporting Regulations: Reporting Requirements for Health Care Facilities 333‑010‑0030
Cancer Reporting Regulations: Reporting Requirements for Practitioners 333‑010‑0032
Cancer Reporting Regulations: Reporting Requirements for Clinical Laboratories 333‑010‑0035
Cancer Reporting Regulations: Patient Notification Requirement 333‑010‑0040
Cancer Reporting Regulations: Quality Standards 333‑010‑0050
Cancer Reporting Regulations: Confidentiality and Access to Data 333‑010‑0055
Cancer Reporting Regulations: Research Studies 333‑010‑0060
Cancer Reporting Regulations: Special Studies 333‑010‑0070
Cancer Reporting Regulations: Advisory Committee 333‑010‑0080
Cancer Reporting Regulations: Training and Consultation 333‑010‑0090
Cancer Reporting Regulations: Fees 333‑010‑0100
ScreenWise Breast and Cervical Cancer Program: Description of the ScreenWise Breast and Cervical Cancer Program 333‑010‑0105
Definitions 333‑010‑0110
Client Eligibility 333‑010‑0115
Client Enrollment 333‑010‑0120
Covered Services 333‑010‑0125
Excluded Services 333‑010‑0130
Standards of Care for Breast and Cervical Cancer Screening and Diagnostic Services 333‑010‑0135
Provider Enrollment 333‑010‑0140
Billing 333‑010‑0145
Claims and Data Submission 333‑010‑0150
Timely Submission of Claims and Data 333‑010‑0155
Payment 333‑010‑0160
Requirements for Financial, Clinical and Other Records 333‑010‑0165
Compliance with Federal and State Statutes 333‑010‑0170
Denial or Recovery of Reimbursement Resulting from Review or Audit 333‑010‑0175
Recovery of Overpayments to Providers Resulting from Review or Audit 333‑010‑0180
Provider Sanctions 333‑010‑0185
Provider Appeals 333‑010‑0190
Provider Appeals (Level 1) — Claims Reconsideration 333‑010‑0195
Provider Appeals (Level 2) — Contested Case Hearing 333‑010‑0197
Presumptive Eligibility for BCCTP 333‑010‑0200
ScreenWise WISEWOMAN Program: Description of the WISEWOMAN Program 333‑010‑0205
Definitions 333‑010‑0210
Client Eligibility 333‑010‑0215
Client Enrollment 333‑010‑0220
Provider Enrollment 333‑010‑0225
Standards of Care for WISEWOMAN Program Screening and Services 333‑010‑0230
Submission of Information by Ancillary Providers 333‑010‑0235
Covered Services 333‑010‑0240
Excluded Services 333‑010‑0245
Claims and Billing 333‑010‑0250
Payment 333‑010‑0255
Denial or Recovery of Reimbursement Resulting from Review or Audit 333‑010‑0260
Recovery of Overpayments to Providers Resulting from Review or Audit 333‑010‑0265
Client Data Submission 333‑010‑0270
Requirements for Financial, Clinical and Other Records 333‑010‑0275
Compliance with Federal and State Statutes 333‑010‑0280
Provider Sanctions 333‑010‑0285
Provider Appeals (Level 1) — Claims Reconsideration 333‑010‑0290
Provider Appeals (Level 2) — Contested Case Hearing 333‑010‑0300
Tobacco Prevention and Education Program: Definitions 333‑010‑0310
Tobacco Prevention and Education Program: Purpose and Intent 333‑010‑0320
Tobacco Prevention and Education Program: Framework for Grant Awards 333‑010‑0330
Tobacco Prevention and Education Program: Local Coalitions and Community-Based Programs 333‑010‑0350
Tobacco Prevention and Education Program: Statewide Public Awareness and Education Programs 333‑010‑0360
Tobacco Prevention and Education Program: Statewide and Regional Projects Programs 333‑010‑0370
Tobacco Prevention and Education Program: Reporting 333‑010‑0600
Childhood Diabetes Database: Definitions 333‑010‑0610
Childhood Diabetes Database: General Authority and Purpose 333‑010‑0620
Childhood Diabetes Database: Reporting Requirements for Schools 333‑010‑0630
Childhood Diabetes Database: Reporting Requirements for Practitioners 333‑010‑0640
Childhood Diabetes Database: Confidentiality and Access to Data 333‑010‑0650
Childhood Diabetes Database: Research Studies 333‑010‑0660
Childhood Diabetes Database: Advisory Committee 333‑010‑0700
Dental Pilot Projects: Purpose 333‑010‑0710
Dental Pilot Projects: Definitions 333‑010‑0720
Dental Pilot Projects: Application Procedure 333‑010‑0730
Dental Pilot Projects: Application Review Process 333‑010‑0740
Dental Pilot Projects: Project Application Provisional Approval or Denial 333‑010‑0750
Dental Pilot Projects: Provisional Approval 333‑010‑0760
Dental Pilot Projects: Minimum Standards 333‑010‑0770
Dental Pilot Projects: Informed Consent 333‑010‑0780
Dental Pilot Projects: Pilot Project Evaluation and Monitoring by Sponsor 333‑010‑0790
Dental Pilot Projects: Authority Responsibilities 333‑010‑0800
Dental Pilot Projects: Project Modifications 333‑010‑0810
Dental Pilot Projects: Discontinuation or Completion of Project 333‑010‑0820
Dental Pilot Projects: Suspension, Denial or Termination of Project
Last Updated

Jun. 8, 2021

Rule 333-010-0180’s source at or​.us