Section 515.8 - Mandatory exclusions.

515.8 Mandatory exclusions. (a) Notwithstanding any provision of this Title to the contrary, the following persons are immediately excluded from participation in the medical assistance program:

(1) A person who is excluded or terminated from participation in the Federal Medicare program;

(2) A health maintenance organization (HMO) furnishing services under a waiver granted pursuant to federal law when:

(i) any affiliate of such HMO or person with whom the HMO has a significant business transaction is convicted of a criminal offense under section 1128 of the Federal Social Security Act;

(ii) any affiliate of such HMO or person with whom the HMO has a significant business transaction is assessed civil money penalties under section 1128A of the Federal Social Security Act; or

(iii) such HMO has been excluded from the Federal Medicare program or any state's health care program.

(b) Appeals. A person sanctioned under this section is not entitled to an administrative hearing but may, within 30 days of the date of the notice, submit written arguments and documentation regarding whether the determination was based upon mistake of fact.

 

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