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Vermont Administrative Code §13 170 710

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“Violations of provider responsibility under the Agency of Human Services regulations”

The Department for Children and Families may impose sanctions against a provider for:

  • Submitting  a false claim for care or services;
  • Submitting false information to obtain greater compensation than what the provider is legally entitled;
  • Submitting false information to meet prior authorization requirements;
  • Submitting a false application to obtain provider status;
  • Failing to disclose to the department records of services provided to Medicaid beneficiaries and records of payments received for those services;
  • Over-utilizing the Medicaid program by inducing, furnishing or otherwise causing a beneficiary to receive care and services not required by the beneficiary.

Sanctions include:

  • Exclusion from participation in the Medicaid program;
  • Suspension from participation in the Medicaid program;
  • Deferment or offsetting 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;
  • 100 percent review of the provider's claims prior to payment; or
  • Recovery of overpayment by offset or civil action, including recovery of reasonable interest and costs.


Current as of June 2015