Section 516.5 - Effect and enforcement of the penalty.

516.5 Effect and enforcement of the penalty. (a) For each claim the department is authorized to recover any overpayment, unauthorized payment, or otherwise inappropriate payment and if twenty-five percent or more of those claims which are the subject of an audit by the department result in overpayments, unauthorized payments or otherwise inappropriate payments and for which the claims were submitted by a person for payment under the medical assistance program, the department may also impose a monetary penalty against any person, or persons, who received the overpayment, unauthorized payment or otherwise inappropriate payment for such claim. If less than twenty-five percent of identified claims result in overpayments, unauthorized payments or otherwise inappropriate payments then the department may recover such monies or may impose a monetary penalty, but not both.

(b) Despite the imposition of a penalty, the department may exclude a person who is a provider of care, services or supplies from participating in the MA program pursuant to Part 515 of this Title.

(c) The imposition of any penalty under this Part does not preclude the imposition of any other penalty prescribed by either federal or State law or regulation.

(d) Where the person against whom the penalty was imposed does not pay the penalty, the department may recover the amount of the penalty in the same manner as the recovery of an overpayment as set forth in Part 518 of this Title or by any other means available to the department.

(e) Interest will accrue on the amount of the penalty commencing on the 90th day after the date of the department's notice. Interest will accrue at the rate set forth in section 518.4(c) of this Title. (f) The department may not recover overpayments, unauthorized payments or otherwise inappropriate payments from any person, or persons, for a single claim, in an amount that exceeds the amount paid for such claimed. (g) The department is authorized to recover both any overpayment, unauthorized payment or otherwise inappropriate payment and impose a monetary penalty against any person, or persons, other than a recipient of an item or service under MA, who caused the overpayment, unauthorized payment or otherwise inappropriate payment to be received by the other person or persons. These actions, in addition to the other actions under this section, may be taken by the department for the same claim.

Doc Status: 
Complete
Effective Date: 
Wednesday, February 25, 2009