Or. Admin. Code § 333-004-4120 - Grounds for Sanctions; Sanctions

(1) The following may result in the imposition of a sanction against an authorized agency or authorized provider:

(a) Interference with the investigation of health care fraud;

(b) Conviction for unlawfully manufacturing, distributing, prescribing, or dispensing a controlled substance;

(c) An action by a state licensing authority relating to a provider's professional competence, professional conduct, or financial integrity, that results in the provider either:

(A) Having their license suspended or revoked; or

(B) Surrendering the license while a formal disciplinary proceeding was pending before a licensing authority.

(d) Suspension or exclusion from participation in a federal or state-administered health care program for reasons related to professional competence, professional performance, or other reason;

(e) Threatening, intimidating, or harassing clients or their relatives;

(f) Participation in collusion that resulted in an inappropriate money flow between the parties involved, for example, referring clients unnecessarily to another provider;

(g) Submittal of fraudulent claims;

(h) Unauthorized or unlawful disclosure of client information; or

(i) Failure to comply with OAR 333-004-4000 through 333-004-4130.

(2) The RH Program shall consider the following factors in determining whether to issue a sanction and the sanction to be imposed:

(a) Nature of the violation or offense;

(b) Extent of the violations;

(c) History of prior violations;

(d) Prior imposition of sanctions;

(e) Cooperation with an investigation; and

(f) Whether the action, sanction or exclusion was the result of a state having passed a law making abortion services unlawful.

(3) Sanctions may include one or more of the following:

(a) A requirement that payment for certain services are made only after the RH Program has reviewed documentation supporting the services.

(b) Prohibition from receiving payment for abortion services under the Abortion Access Plan in the future.

Notes

Or. Admin. Code § 333-004-4120

PH 47-2023, adopt filed 09/28/2023, effective 10/1/2023; PH 112-2024, minor correction filed 11/26/2024, effective 11/26/2024

Statutory/Other Authority: ORS 413.042 & ORS 435.230

Statutes/Other Implemented: ORS 413.032 & ORS 435.230