Section 16.05.07.210 - SUSPENSION OF PAYMENTS PENDING INVESTIGATIONThe Department may suspend public-assistance payments in whole or part in a suspected case of fraud or abuse pending investigation and conclusion of legal proceedings related to the provider's alleged fraud or abuse. When payments have been suspended under this rule, the Department will provide for a hearing within thirty (30) days of receipt of any timely filed notice of appeal.
01.Basis for Suspension of Payments. When the Department through reliable evidence suspects fraud or abuse, or when a provider fails to provide immediate access to records, public-assistance payments may be withheld or suspended.02.Notice of Suspension of Payments. The Department may withhold public-assistance payments without first notifying the provider of its intention to do so when the Department is suspending payments of a Medicaid provider. The Department will send written notice within five (5) days of taking such action under 42 CFR 455.23(b). All other public assistance providers will be notified prior to the suspension of payments.03.Duration of Suspension of Payments. The withholding of payment actions under this rule will be temporary and will not continue after: a. The Department or the prosecuting authorities determine there is insufficient evidence of fraud or willful misrepresentation by the provider; orb. Legal proceedings related to the provider's alleged fraud or abuse are completed.Idaho Admin. Code r. 16.05.07.210