1. (1) In addition to other remedies allowed by law and unless specified otherwise, the Department may withhold payments to a provider or contractor if:

   1. (a) the provider or contractor fails to provide the requested information within 30 calendar days from the date of a written request for information;
   2. (b) the provider or contractor has an outstanding balance owing the Department for any reason; or
   3. (c) the provider or contractor receives more than $5,000,000 in reimbursement annually from the Department and fails to comply with 42 U.S.C. 1396a(a)(68).

2. (2) The Department or the Office of the Inspector General of Medicaid Services may determine a provider or contractor to be noncompliant if the provider or contractor cannot submit, upon request:

   1. (a) an attestation of compliance with the Social Security Act, 42 U.S.C. 1396a(a)(68); and
   2. (b) an attestation of compliance with the False Claims Act, 31 U.S.C. Sections 3729 through 3733.
3. (3) The Department shall provide written notice before withholding payments.
4. (4) When the Department rescinds withholding of payments to a provider or contractor, it will, without notice, resume payments according to the regular claims payment cycle.

KEY: Medicaid

Date of Last Change: May 1, 2026

Notice of Continuation: December 13, 2021

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-1004; 26B-8-132