405 Ind. Admin. Code 1-1.4-5

Current through October 2, 2024

Section 405 IAC 1-1.4-5 - Payment suspension procedures

Authority: IC 12-8-6.5-5; IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2

Affected: IC 4-21.5-3-7; IC 4-21.5-4

Sec. 5.

(a) This rule applies to a credible allegation of fraud defined in 42 CFR 455.2. The office will investigate an allegation of fraud it receives from any source. If, during the course of its investigation, the office determines that there is a credible allegation of fraud against a provider, the office shall:

(1) refer the case to the IMFCU; and

(2) suspend Medicaid payments pursuant to 42 CFR 455.23 and the requirements therein.

(b) Unless otherwise provided, the office shall send a provider notice of the payment suspension in accordance with the procedures in 42 CFR 455.23(b) and subject to the exceptions therein.

(c) A provider or entity subject to payment suspension under section (a) [subsection (a)] may appeal the payment suspension under section 11 or 12 of this rule, as applicable.

405 IAC 1-1.4-5

Office of the Secretary of Family and Social Services; 405 IAC 1-1.4-5; filed 12/21/2018, 3:17 p.m.: 20190116-IR-405180251FRA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA