Denial of application to become a qualified service provider

The department may deny an application to become a qualified service provider if: 1. The applicant voluntarily withdraws the application; 2. The applicant is not in compliance with applicable state laws, state regulations, or program issuances governing providers; 3. The applicant, if previously enrolled as a qualified service provider, was not in compliance with the terms set forth in the application or provider agreement; 4. The applicant, if previously enrolled as a qualified service provider, was not in compliance with the provider certification terms on the claims submitted for payment; 5. The applicant, if previously enrolled as a qualified service provider, had assigned or otherwise transferred the right to payment of a program claim, except as provided in 42 U.S.C. 1396a(a) (32); 6. The applicant, if previously enrolled as a qualified service provider, had demonstrated a pattern of submitting inaccurate billings or cost reports; 7. The applicant, if previously enrolled as a qualified service provider, had demonstrated a pattern of submitting billings for services not covered under department programs; 8. The applicant has been debarred or the applicant's license or certificate to practice in the applicant's profession or to conduct business has been suspended or terminated; 9. The applicant has delivered goods, supplies, or services that are of an inferior quality or are harmful to individuals; 10. The applicant has been convicted of an offense determined by the department to have a direct bearing upon the applicant's ability to be enrolled as a qualified service provider, or the department determines, following conviction of any other offense, the applicant is not sufficiently rehabilitated; 11. The applicant, if previously enrolled as a qualified service provider, owes the department money for payments incorrectly made to the provider; 12. The qualified service provider is currently excluded from participation in Medicare, Medicaid, or any other federal health care program; 13. The applicant has not provided sufficient evidence to the department, after obtaining a formal evaluation under subsection 3 of section 75-03-23-07, that the applicant is physically, cognitively, socially, or emotionally capable of providing the care; 14. The applicant previously has been terminated for inactivity and does not have a prospective public pay-eligible individual; 15. The applicant previously has been terminated for inactivity and has not provided valid reason for the inactivity; or 16. For other good cause.