Section 515.3 - Authority to sanction.

515.3 Authority to sanction. (a) Upon a determination that a person has engaged in an unacceptable practice, the department may impose one or more of the following sanctions:

(1) exclusion from the program for a reasonable time;

(2) censure; or

(3) conditional or limited participation, such as requiring preaudit or prior authorization of claims for all medical care, services or supplies, prior authorization of specific medical care, services or supplies, or other similar conditions or limitations.

(b) The department may also require the repayment of overpayments determined to have been made as a result of an unacceptable practice.

(c) Whenever the department sanctions a person, it may also sanction any affiliate of that person; provided, however, that in imposing a sanction upon an affiliate, the determination must be made on a case-bycase basis giving due regard to all the relevant facts and circumstances leading to the original sanction.

(d) In determining whether or not to sanction a person, the department may hold that person responsible for the conduct of another person. However, conduct may only be imputed to another when the persons are affiliates of each other, and the conduct was accomplished within the course of the duties of the person to be sanctioned and the other person knew or should have known of the conduct, or the conduct was effected with the knowledge and consent of the other.

 

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