N.Y. Comp. Codes R. & Regs. Tit. 18 § 515.5 - Sanctions; effect
(a) No payments
will be made to or on behalf of any person for the medical care, services or
supplies furnished by or under the supervision of the person during a period of
exclusion or in violation of any condition of participation in the program. In
the case of a hospital, nursing home or home health care provider, the
department may continue payments for up to 30 days after the date of exclusion
for clients admitted prior to the exclusion or whose plan of care was
implemented prior to the exclusion.
(b) No payment will be made for medical care,
services or supplies ordered or prescribed by any person while that person is
excluded, nor for any medical care, services or supplies ordered or prescribed
in violation of any condition of participation in the program. The department
may pay the first claim(s) submitted by or on behalf of a dispensing provider
for care, services or supplies ordered or prescribed by an excluded person
after the date of exclusion and notify the dispensing provider of the
exclusion. The department may not pay for any care, services or supplies
ordered or prescribed by an excluded person more than 20 days after the date of
a notice of an exclusion to a dispensing provider.
(c) A person who is excluded from the program
cannot be involved in any activity relating to furnishing medical care,
services or supplies to recipients of medical assistance for which claims are
submitted to the program, or relating to claiming or receiving payment for
medical care, services or supplies during the period.
(d) Providers reimbursed on a cost-related
basis may not claim as allowable costs any amounts paid or credited to any
person who is excluded from the program or who is in violation of any condition
of participation in the program.
(e) Providers reimbursed on a
fee-for-services basis may not submit any claim and cannot be reimbursed for
any medical care, services or supplies furnished by any person who is excluded
from the program or which are furnished in violation of any condition of
participation in the program.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.