Miscellaneous Corrective Actions

The Department may take lesser action to investigate, monitor and correct suspected instances of fraud, abuse, over utilization, and other misconduct as provided in this rule. (3-17-22) 01. Issuance of a Warning. Issuance of a warning letter describing the nature of suspected violations, and requesting an explanation of the problem and a warning that additional action may be taken if the action is not justified or discontinued. (3-17-22) 02. Review. Prepayment review of all or selected claims submitted by the provider with notice that claims failing to meet written guidelines will be denied. (3-17-22) 03. Referral. Referral to state licensing boards for review of quality of care and professional and ethical conduct. (3-17-22) 271. -- 274. (RESERVED)