Provider Agreement Terminations - Noncompliance with

3030 - Provider Agreement Terminations - Noncompliance with §§1866(b)(2)(A) and (C) (Rev. 1, 05-21-04) 3030A - Cause for Termination (Rev. 1, 05-21-04) Under the provisions of §§1866(b)(2)(A) and (C) of the Act (also 42 CFR 489.53), the Secretary may terminate an agreement with a provider of services if it is determined that the provider: • Is not complying substantially with the terms of the agreement, the provisions of title XVIII, or regulations promulgated thereunder; • Has failed to supply information necessary to determine whether payments are or were due and the amounts of such payments; • Refuses to permit examination of fiscal and other records (including medical records) necessary for the verification of information furnished as a basis for claiming payment under the Medicare program; or • Refuses to permit photocopying of any records or other information necessary to determine or verify compliance with participation requirements. 3030B - Preparing Termination Cases (Rev. 1, 05-21-04) The RO apprises the provider of its obligations and the consequences of continued violation before considering the need for terminating the agreement. Contacts with the provider may be made through the intermediary or by the RO staff, at the RO’s discretion. In corresponding with the provider, the RO uses certified mail with a return receipt requested. The RO bases termination on documentation that supports a finding that the provider is not complying with the terms of the agreement or the provisions of title XVIII and implementing regulations. 3030C - Preliminary Notice to Provider (Rev. 1, 05-21-04) The RO notifies the provider by letter that the findings and recommendations are being considered and that, if the findings are affirmed, the provider will receive official notice of termination of participation and the effective date on which the agreement is to be terminated. The RO advises the provider that when the official notice is released, it may be changed only if the determination is reversed upon appeal. Also the RO advises the provider to contact your office if it has taken steps to correct the violation or has definite plans for doing so. 3030D - Violation of §§1866(b)(2)(A) and (C) (Rev. 1, 05-21-04) The RO notifies the provider that notice will be placed in the local newspaper(s) advising the public in accordance with the provisions of title XVIII. The RO explains the effect of the termination with respect to services furnished on or after the termination date, and advises the provider of the right to a hearing and the manner of filing for it. After the official notice of termination of participation is released to the provider, the RO proceeds with publication of the public notice. (See §§3034 and 3036.) On the day before the public notice is published, the RO calls the intermediary and advises them of the termination. The RO cautions the intermediary not to divulge this information before the notice is published. Following publication, the RO formally notifies the SA.