1. (1) The following may result in the imposition of a sanction against an agency:

   1. (a) Interference with the investigation of health care fraud;
   2. (b) Conviction for unlawfully manufacturing, distributing, prescribing, or dispensing a controlled substance;

   3. (c) An action by a state licensing authority relating to a provider's professional competence, professional conduct, or financial integrity, that results in the provider either:

      1. (A) Having their license suspended or revoked; or
      2. (B) Surrendering the license while a formal disciplinary proceeding was pending before a licensing authority.
   4. (d) Suspension or exclusion from participation in a federal or state-administered health care program for reasons related to professional competence, professional performance, or other reason;
   5. (e) Threatening, intimidating or harassing clients or their relatives in an attempt to influence payment rates or affect the outcome of disputes between the provider and the RH Program;
   6. (f) Participation in collusion that resulted in an inappropriate money flow between the parties involved, for example, referring clients unnecessarily to another provider;
   7. (g) For claims paid using CCare funds, any sanctions outlined in OAR 410-120-1400 (HSD Medicaid Programs, General Administrative Rules);
   8. (h) Unauthorized or unlawful disclosure of client information; and
   9. (i) Failure to comply with these rules.

2. (2) The RH Program shall consider the following factors in determining whether to issue a sanction and the sanction to be imposed:

   1. (a) Nature of the violation or offense;
   2. (b) Extent of the violations by the agency;
   3. (c) History of prior violations by the agency;
   4. (d) Prior imposition of sanctions;
   5. (e) Prior notification of compliance findings; and
   6. (f) Cooperation with an investigation.

3. (3) Sanctions may include one or more of the following:

   1. (a) Termination of certification;
   2. (b) Imposition of a Corrective Action Plan;
   3. (c) A requirement to attend provider education sessions at the expense of the sanctioned agency;
   4. (d) A requirement that payment for certain services are made only after the RH Program has reviewed documentation supporting the services; and
   5. (e) For claims paid using CCare funds, any action authorized under OAR 410-120-1460 (HSD Provider Sanctions).

Statutory/Other Authority

ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149, ORS 435.205 & ORS 435.230

Statutes/Other Implemented

ORS 414.432, ORS 431.147, ORS 413.032, ORS 435.205 & ORS 435.230

History

PH 96-2024, minor correction filed 11/26/2024, effective 11/26/2024
PH 202-2022, amend filed 10/27/2022, effective 10/27/2022
PH 84-2020, adopt filed 12/18/2020, effective 01/01/2021