(a) The Department may terminate providers under the following conditions: - (i) Fraud, theft, or abuse of services;
- (ii) Lack of, or repeated failure to provide documentation of Medicaid services;
- (iii) Inability to collect overpayments;
- (iv) Failure to comply with the provisions of the provider agreement;
- (v) Violation of Medicaid, Department, or other state or federal statute, rule, or law requiring termination of the provider;
- (vi) If a provider is excluded by Office of Inspector General (OIG);
- (vii) If a provider has not submitted any paid claims for over one (1) year; or
- (viii) If a provider has been terminated under Medicare, CHIP or another state's Medicaid program.
(b) Effect of termination. - (i) The termination under this section shall be the same as termination from the licensing agency, Medicare or the voluntary non-participation from either, if these are a requirement of Medicaid enrollment;
- (ii) A terminated provider shall not submit any claims, either personally or through a third party payer, clinic, group or other association, for any services provided after the effective date of the termination;
- (iii) No clinic, group, corporation, professional association or other organization shall submit any claim for services provided by an individual provider within such organization after the effective date of the individual provider's termination; and
- (iv) The Department shall not pay any claims submitted by a provider for services provided to a client after the effective date of termination.
(c) The Department may terminate any and all provider numbers that have the same tax identification number as the provider number that has been terminated.
(d) Reapplication. Once terminated, a provider must reapply in order to provide services. Previously terminated providers shall not provide services for Medicaid until: - (i) The Department has been reimbursed for all overpayments; and
- (ii) The Department is satisfied that sufficient safeguards have been installed to insure that the fraud, theft, or abuse of services, or other factors which led to the termination, will not recur.
(e) No obligation to reinstate. The Department shall not be obligated to reinstate a terminated provider even if the requirements of subsection 17(c) above are satisfied.
048-16 Wyo. Code R. § 16-17