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12-6 Vt. Code R. 4:6 - Sanctioning under the Agency of Human Services regulations

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“Sanctioning under the Agency of Human Services regulations”

The Department of Mental Health may impose sanctions against a provider for:

  • Presenting a false claim for mental health  care or services to Medicaid;
  • Submitting false application to obtain provider status;
  • Failing to disclose to the Department of Mental Health records of services provided to Medicaid recipients and records of payments received for those services;
  • Over-utilizing Medicaid by providing care to a patient that is unnecessary.

Sanctions include:

  • Exclusion from participation in the Medicaid and Medicare programs;
  • Deferment of payments to a provider;
  • Transfer to a closed-end provider agreement not to exceed 12 months;
  • Mandatory attendance at provider information sessions;
  • Required prior authorization of service; and
  • 100% review of the provider’s claims prior to payment.


Current as of June 2015