TITLE 40
Human services

CHAPTER 40-8.2
Medical Assistance Fraud

SECTION 40-8.2-21


§ 40-8.2-21 Suspension of payments to a provider.

(a) The executive office of health and human services may issue a suspension of payments order if:

(1) The provider does not meet certification requirements of the Rhode Island Medicaid program; or

(2) The Rhode Island Medicaid program has been unable to collect (or make satisfactory arrangements for the collection of ) amounts due on account of overpayments to any provider; or

(3) The office of program integrity and/or the Medicaid fraud control unit of the attorney general's office has been unable to obtain, from a provider, the data and information necessary to enable it to determine the existence or amount (if any) of the overpayments made to a provider; or

(4) The office of program integrity or the Medicaid fund control unit of the attorney general's office has been denied reasonable access to information by a provider which pertains to a patient or resident of a long term residential care facility or to a former patient or resident of a long term residential care facility; or

(5) The office of program integrity and/or the Medicaid fraud control unit of the attorney general's office has been denied reasonable access to data and information by the provider for the purpose of conducting activities as described in § 1903(g) of the Social Security Act, 42 U.S.C. § 1396b(g); or

(6) The office of program integrity has been presented with reliable evidence that the provider has engaged in fraud or willful misrepresentation under the Medicaid program.

(b) Any such order of the executive office of health and human services may cease to be effective at such time as the office of program integrity is satisfied that the provider is participating in substantial negotiations which seek to remedy the conditions which gave rise to its order of suspension of payments, or that amounts are no longer due from the provider or that a satisfactory arrangement has been made for the payment of the provider or that a satisfactory arrangement has been made for the payment by the provider of any such amounts.

History of Section.
(P.L. 1982, ch. 424, § 1; P.L. 1989, ch. 137, § 1; P.L. 2015, ch. 141, art. 5, § 12.)