10 Colo. Code Regs. § 2505-10-8.130.35
Current through Register Vol. 47, No. 11, June 10, 2024
Section 10 CCR 2505-10-8.130.35 - SCREENING FOR EXCLUDED EMPLOYEES AND CONTRACTORSA. As a condition of enrollment and participation in the Medical Assistance Program, each Provider shall comply with the following requirements for screening for employees and contractors who have been excluded from participation in Medicaid and Medicare by the US Department of Health & Human Services Office of Inspector General: 1. Each Provider shall utilize the US Department of Health & Human Services Office of Inspector General's List of Excluded Individuals/Entities (www.oig.hhs.gov) to determine if a prospective employee or newly signed contractor has been excluded from participation in a Medical Assistance Program. a. Such screening should be performed within five (5) business days of the date on which the new employee was hired or new contract was signed. 2. Each Provider shall screen its employees and contractors against the List of Excluded Individuals/Entities at least monthly to capture any exclusions or reinstatements that have occurred since the last search of the database.3. If a Provider determines that an employee or contractor of the Provider has been excluded, then the Provider shall report this to the Department within five (5) business days of the date of discovery.4. Each screening must be documented in a manner that can be provided to the Department upon request.B. Except as otherwise provided in federal law, if the Medical Assistance Program pays for any goods or services furnished, ordered, or prescribed by an excluded individual or entity that is employed by or has contracted with a Provider, such payment shall constitute an overpayment and shall be subject to overpayment recovery, pursuant to Section 8.076. Such Provider may also be subject to sanctions by the Department, including the termination of the Provider agreement, as described at 8.076.5., if the Provider knew or should have known of the exclusion. The Provider may also be subject to civil and monetary penalties imposed by the US Department of Health and Human Services.1. To the extent that such amount can be traced, the amount of the overpayment shall include any funds expended by the Medical Assistance Program to pay the excluded individual's or contractor's salary, expenses, or fringe benefits.C. Subject to federal law and the Department's discretion, failure of a Provider to comply with the screening requirements listed at Section 8.130.35.A. may constitute good cause sufficient to justify termination of the Provider agreement, as described at 8.076.5.44 CR 23, December 10, 2021, effective 1/10/2022