N.M. Admin. Code § 8.351.2.12

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.351.2.12 - IMPOSITION OF SANCTIONS

A.Mandatory sanctions: MAD must impose sanctions when a provider receives a formal reprimand or censure for unethical practice by a professional association of the provider's peers or when a provider is suspended or terminated from participation in medicare or any federal or state-funded health care program. Imposition of sanctions are applied to any provider or other entity receiving payment for services either directly through MAD, its contractor, or through any HSD contracted MCO, subcontractor, or provider.

B.Permissive sanctions: MAD can impose monetary or non-monetary sanctions against a provider or other entity for fraud or other forms of misconduct.

C.Criteria used in assessment of permissive sanctions: MAD uses the following criteria to determine the type of permissive or mandatory sanction to impose:

(1) seriousness of the violation;

(2) number and nature of a violation;

(3) history of a prior violation or prior sanction;

(4) action or recommendation of peer review group or licensing board;

(5) nature and degree of adverse impact of the sanction upon a MAP eligible recipient;

(6) cost to MAD or a HSD contracted MCO of the violation;

(7) mitigating circumstances; and

(8) other relevant facts.

N.M. Admin. Code § 8.351.2.12

8.351.2.12 NMAC - Rp, 8.351.2.12 NMAC, 1-1-14