(a) To participate
in the MA Program, a physician shall have and maintain a current license.
(1) Services rendered, ordered, arranged for
or prescribed for MA recipients by a physician whose license to practice
medicine has expired are not eligible for payment under the MA
Program.
(2) Refer to §
1101.42 (relating to prerequisites
for participation) and 49 Pa. Code Chapters 16, 17 and 25 (relating to State
Board of Medicine-general provisions; State Board of Medicine-medical doctors;
and State Board of Osteopathic Medicine) for additional requirements.
(3) The Department intends to periodically
monitor the expiration of medical licenses to ensure compliance with MA
regulations.
(b) The
Department will initiate action to recover monies from a physician for one or
both of the following:
(1) Medical services
billed directly by the physician during the period in which his license is
expired.
(2) Services ordered,
arranged for or prescribed by the physician whose license has expired,
including the services of other providers such as laboratories, radiologists,
pharmacies, inpatient and outpatient hospitals and nursing homes that bill the
Department for the ordered, arranged or prescribed
services.
(c) A physician
may not bill the recipient or another provider/person for services for which
the Department has requested restitution.
(d) If the physician decides to eventually
renew his license, the amount collected for services rendered, ordered,
arranged for or prescribed during the unlicensed period will not be returned,
and restitution requested shall be paid before reinstatement into the MA
Program is considered.
Notes
The
provisions of this § 1101.42a adopted September 1, 1989, effective immediately,
retroactively applicable to July 1, 1988, 19 Pa.B.
3762.
This section cited in 55 Pa. Code §
1121.41 (relating to participation
requirements); 55 Pa. Code §
1123.41 (relating to participation
requirements); 55 Pa. Code §
1127.41 (relating to participation
requirements); 55 Pa. Code §
1128.41 (relating to participation
requirements); 55 Pa. Code §
1141.41 (relating to participation
requirements); 55 Pa. Code §
1142.41 (relating to participation
requirements); 55 Pa. Code §
1143.41 (relating to participation
requirements); 55 Pa. Code §
1144.41 (relating to participation
requirements); 55 Pa. Code §
1149.41 (relating to participation
requirements); and 55 Pa. Code §
1251.41 (relating to participation
requirements).
