1. A. Any provider who fails to comply with any obligation this Chapter requires or engages in any conduct this Chapter prohibits is subject to one or more of the following sanctions:

   1. 1. require the provider receive prior authorization for any or all services provided under the Medicaid program;
   2. 2. require some or all of the provider’s claims be subject to manual review;
   3. 3. require the provider post a bond or other security as a condition of continued enrollment;
   4. 4. require the provider terminate its association with a provider-in-fact, employee, agent, contractor, or affiliate as a condition of continued enrollment;
   5. 5. prohibit the provider from associating, employing, or contracting with a specific person or entity as a condition of continued participation in the Medicaid program;
   6. 6. prohibit the provider from performing specified tasks, providing services at designated locations, or providing services to designated recipients or classes or types of recipients;
   7. 7. prohibit the provider from referring recipients to another designated person or purchasing services from designated persons;
   8. 8. recovery;
   9. 9. exclusion from the Medicaid program;
   10. 10. suspension from the Medicaid program;
   11. 11. require the forfeiture of a bond or other security;
   12. 12. imposition of monetary penalties up to $10,000 per violation; or
   13. 13. imposition of an administrative fine up to three times the overpayment.
2. B. Unless stated otherwise in this Chapter, the sanction(s) imposed is within the discretion of the PIU section chief with the concurrence of the BHSF director.
3. C. When a sanction is imposed pursuant to this Section, the provider shall be responsible for reasonable costs of investigation the department incurred. This includes costs for the department’s time and expenses its employees, agents, or contractors incurred. The department may waive recovery of costs and expenses when resolving a matter.
4. D. Providers shall be assessed judicial interest on any outstanding recovery at the maximum rate provided by R.S. 13:4202. The department may waive or agree to reduce the amount of any interest assessed.

5. E. The department may obtain payment on any monetary sanction by offsetting any remittance due to a provider on a fee-for-service payment. If provided for in the contract between the MCO and LDH, the department may obtain payment on any monetary sanction due from a managed care provider by offsetting PMPMs due to the MCO.

   1. 1. The amount and duration of any offset is within the discretion of the PIU section chief or the BHSF director.
   2. 2. The amount and duration of an offset is not a separate sanction and it is not subject to an informal hearing or appeal.

6. F. In determining the sanction, the PIU section chief and/or the BHSF director may consider the totality of circumstances, including but not limited to:

   1. 1. seriousness of the violation(s);
   2. 2. extent of the violation(s);
   3. 3. history of prior violation(s);
   4. 4. prior imposition of sanction(s);
   5. 5. prior provision of education;
   6. 6. willingness to obey program rules;
   7. 7. actions taken or recommended by peer review groups or licensing boards;
   8. 8. adverse actions an MCO has assessed on a provider;
   9. 9. cooperation with departmental or other healthcare oversight agency reviews or investigations;
   10. 10. willingness to repay the identified overpayment; and
   11. 11. ability to repay identified overpayments.
7. G. Unless stated otherwise in this Chapter, the sanction imposed is within the discretion of the PIU section chief with the concurrence of the BHSF director.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 46:437.1-46:440.3.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 52:695 (May 2026).