1. A. The Administrator of the Title XIX Single State Agency may invoke one (1) or more of the following administrative sanctions against a Medicaid provider who has been determined to have abused the Medicaid Program:

   1. (1) Educational Intervention;
   2. (2) Postpayment Review of Claims;
   3. (3) Prepayment Review of Claims;
   4. (4) Referral to Licensing/Certifying Boards or Agencies;
   5. (5) Peer Review;
   6. (6) Suspension;
   7. (7) Termination.

2. B. The Administrator of the Title XIX Single State Agency may invoke one (1) or more of the following administrative sanctions against a Medicaid provider who has been determined to be guilty of fraud or convicted of a crime related to his or her participation in Medicare or Medicaid, or for any reason for which the Secretary of the United States Department of Health and Human Services could exclude an individual or entity under 42 CFR Sections 1001 and 1003. [42 CFR Section 1002.210]:

   1. (1) Suspension;
   2. (2) Termination;
   3. (3) Exclusion.

HISTORY: Amended by SCSR42-5 Doc. No. 4746, eff May 25, 2018.