Ch. 16, § 16. Suspension and Termination of Provider

(a) A suspension or termination under this section shall be the same and shall run contemporaneously with the period of the provider's suspension from a licensing entity, Medicare, another State Medicaid Agency or any period of voluntary non-participation. (b) A suspended or terminated provider shall not submit any claims, either personally or through a third party payer, clinic, group or other association, for any services provided after the effective date of the suspension; (c) No clinic, group, corporation, professional association or other organization shall submit any claim for services provided by an individual provider within such organization after the effective date of the individual provider's suspension or termination; and (d) The Department shall not pay any claims submitted by a provider for services provided to a client during any period of suspension or after a provider has been terminated. (e) The Department may suspend any and all provider numbers that have the same tax identification number as the provider number that has been suspended or terminated. (f) This section does not preclude the filing of claims prior to a termination. Any filed claims may be held in suspense until a final decision is rendered on the termination. (g) The Department may reinstate or reenroll a suspended or terminated provider if: (i) The Department has been reimbursed for all overpayments or a payment agreement is in effect; (ii) The Department is satisfied that sufficient safeguards have been implemented to insure that fraud, waste, or abuse of services, or other factors which led the suspension or termination, will not recur; and (iii) For terminated providers, an approved new provider agreement is signed by all parties.