La. Admin. Code tit. 50 § I-4165

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-4165 - Imposition of Sanction(s)

A. The decision as to the sanction(s) to be imposed shall be at the discretion of the director of BHSF or his/her designee and the director of Program Integrity except as provided for in this provision, unless the sanction is mandatory. In order to impose a sanction, the director of BHSF or his/her designee and the director of Program Integrity must concur. One or more sanctions may be imposed for a single violation. The imposition of one sanction does not preclude the imposition of another sanction for the same or different violations.

B. At the discretion of the director of BHSF or his/her designee and the director of Program Integrity, each occurrence of misconduct may be considered a violation or multiple occurrences of misconduct may be considered a single violation or any combination thereof.

C. The following factors may be considered in determining the sanction(s) to be imposed:

1. seriousness of the violation(s);

2. extent of the violation(s);

3. history of prior violation(s);

4. prior imposition of sanction(s);

5. prior provision of education;

6. willingness to obey program rules;

7. whether a lesser sanction will be sufficient to remedy the problem;

8. actions taken or recommended by peer review groups or licensing boards;

9. cooperation related to reviews or investigations by the department or cooperation with other investigatory agencies; and

10. willingness and ability to repay identified overpayments.

La. Admin. Code tit. 50, § I-4165

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 25:1645 (September 1999), repromulgated LR 29:599 (April 2003), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38: 2784 (November 2012).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, 46:437.4 and 46:437.1-46:440.3 (Medical Assistance Program Integrity Law)