(a) The
Department, in accordance with section 1902(a)(30) of the Social Security Act
(42 U.S.C.A. §
1396(a)(30)), has
established procedures for reviewing the utilization of, and payment for,
Medical Assistance services. Providers are required, upon request, to furnish
the Department or its designated agents, the Office of the Attorney General or
the Secretary of Health and Human Services, with medical and fiscal records as
specified in §
1101.51(e)
(relating to ongoing responsibilities of providers). Providers shall cooperate
with audits and reviews made by the Department for the purpose of determining
the validity of claims and the reasonableness and necessity of service provided
or for any other purpose.
(b)
Providers shall submit to the Department or the Secretary of Health and Human
Services or to the Office of the Attorney General of this Commonwealth within
35 days of request, information related to business transactions which shall
include complete information about:
(1) The
ownership of any subcontractor with whom the provider has had business
transactions totaling more than $25,000 during the 12-month period ending on
the date of the request; and
(2)
Any significant business transactions between the provider and any wholly owned
supplier, or between the provider and any subcontractor, during the 5-year
period ending on the date of the request.
Notes
The
provisions of this § 1101.71 amended November 18, 1983, effective
11/19/1983, 13 Pa.B.
3653.
This section cited in 55 Pa. Code §
1101.43 (relating to enrollment
and ownership reporting requirements); 55 Pa. Code §
1127.71 (relating to scope of
claims review procedures); 55 Pa. Code §
1128.71 (relating to scope of
claims review procedures); 55 Pa. Code §
1181.542 (relating to who is
required to be screened); 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA
sanctions); and 55 Pa. Code §
5221.43 (relating to quality
assurance and utilization review).
