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Mich. Comp. Laws Ann. § 400.111e - Grounds for action by director

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The Director of the Department of Community Health may take the actions specified in M.C.L.A. §400.111d for the following:

  1. If the provider fails to disclose required information
  2. Provider fails to correctly apply for enrollment and fails to submit required documentation. 
  3. Provider fails to provide certification or fails to comply with requirements of M.C.L.A. §400.111b
  4. Provider fails to comply with professionally accepted medical standards. 
  5. Provider is convicted of violating the Medicaid False Claims act or other similar federal law.
  6. Provider is convicted of or pleads guilty to a criminal offense or attempted criminal offense relating to the provider’s health care practice in any jurisdiction.
  7. Provider repeats the same behavior he or she was previously sanctioned for. 
  8. Provider distributes supplies or equipment with a prescription. 
  9. Provider is terminated as a participating provider under Medicaid or Medicare.
  10. Provider continues to submit duplicate claims after receiving notice. 
  11. Provider submits a claim for a service that was not provided.
  12. Provider continues to submit claims for medically unnecessary services or services that fall below acceptable medical standards.
  13. Provider continues to submit claims that misrepresent services that were or were not provided to the individual. 
  14. Provider submits claims that misrepresent the services or equipment actually provided.
  15. Provider submits a claim that contains misleading medical information or has been altered or destroyed.
  16. Provider fails to complete the required fields on claim submission forms.
  17. Provider charges Medicaid much higher rate than is charged to the general public.

If a provider has an enrollment sanction against him or her, he or she may not participate in Medicaid for that time.  However, the Director of the Department can reinstate a provider if he or she believes reinstatement would be in the best interests of the program. 

Current as of June 2015