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12-6 Vt. Code R. 4:6 - Sanctioning under the Agency of Human Services regulations
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Current as of June 2015
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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
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