ARSD 67:16:35:03. Claims limited to items and services covered under article

A provider may submit claims only for those supplies and services that the provider knows, or should have known, are covered under this article. A provider, other than a school district, may not submit claims for services to children under the age of 21, if the provider knows or should have known that the services are listed in the child's individual education plan. The submission of a claim containing miscoding that may result in inflated reimbursement or in reimbursement for noncovered services under this article is considered abuse of the program and possible fraud and may be cause for terminating the provider agreement.