Louisiana Revised Statutes 46:437.14 – Grounds for denial or revocation of enrollment
Terms Used In Louisiana Revised Statutes 46:437.14
- Agent: means a person who is employed by or has a contractual relationship with a health care provider or who acts on behalf of the health care provider. See Louisiana Revised Statutes 46:437.3
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:437.3
- Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. Source: OCC
- Fiduciary: A trustee, executor, or administrator.
- Fraud: Intentional deception resulting in injury to another.
- Health care provider: means any person furnishing or claiming to furnish a good, service, or supply under the medical assistance programs, any other person defined as a health care provider by federal or state law or by rule, and a provider-in-fact. See Louisiana Revised Statutes 46:437.3
- Managing employee: means a person who exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operations of a health care provider. See Louisiana Revised Statutes 46:437.3
- Medical assistance programs: means the Medical Assistance Program (Title XIX of the Social Security Act), commonly referred to as "Medicaid" and other programs operated by and funded in the department which provide payment to health care providers. See Louisiana Revised Statutes 46:437.3
- Ownership interest: means the possession, directly or indirectly, of equity in the capital or the stock, or the right to share in the profits, of a health care provider. See Louisiana Revised Statutes 46:437.3
- Payment: means the payment to a health care provider from medical assistance programs funds pursuant to a claim, or the attempt to seek payment for a claim. See Louisiana Revised Statutes 46:437.3
- person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
- Provider agreement: means a document which is required as a condition of enrollment or participation as a health care provider under the medical assistance programs. See Louisiana Revised Statutes 46:437.3
- Recovery: means the recovery of overpayments, damages, fines, penalties, costs, expenses, restitution, attorney fees, or interest or settlement amounts. See Louisiana Revised Statutes 46:437.3
A. The department may deny or revoke enrollment in the medical assistance programs to a health care provider if any of the following are found to be applicable to the health care provider, his agent, a managing employee, or any person having an ownership interest equal to five percent or greater in the health care provider:
(1) Misrepresentation.
(2) Previous or current exclusion, suspension, termination from, or the involuntary withdrawing from participation in, the medical assistance programs, any other state’s Medicaid program, Medicare, or any other public or private health or health insurance program.
(3) Conviction under federal or state law of a criminal offense relating to the delivery of any goods, services, or supplies, including the performance of management or administrative services relating to the delivery of the goods, services, or supplies, under the medical assistance programs, any other state’s Medicaid program, Medicare, or any other public or private health or health insurance program.
(4) Conviction under federal or state law of a criminal offense relating to the neglect or abuse of a patient in connection with the delivery of any goods, services, or supplies.
(5) Conviction under federal or state law of a criminal offense relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance.
(6) Conviction under federal or state law of a criminal offense relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.
(7) Conviction under federal or state law of a criminal offense punishable by imprisonment of a year or more which involves moral turpitude, or acts against persons who are elderly, children, or persons with infirmities.
(8) Conviction under federal or state law of a criminal offense in connection with the interference or obstruction of any investigation into any criminal offense listed in Paragraphs (3) through (9) of this Subsection.
(9) Sanction pursuant to a violation of federal or state laws or rules relative to the medical assistance programs, any other state’s Medicaid program, Medicare, or any other public health care or health insurance program.
(10) Violation of licensing or certification conditions or professional standards relating to the licensure or certification of health care providers or the required quality of goods, services, or supplies provided.
(11) Failure to pay recovery properly assessed or pursuant to an approved repayment schedule under the medical assistance programs.
(12) Failure to meet any condition of enrollment.
B. Before signing a provider agreement and at the discretion of the department, a person may become eligible to receive payment from the medical assistance programs from the time the goods, services, or supplies were furnished, if:
(1) The goods, services, or supplies provided were otherwise compensable.
(2) The person met all other requirements of a health care provider at the time the goods, services, or supplies were provided.
(3) The person agrees to abide by the provisions of the provider agreement to be effective from the date the goods, services, or supplies were provided.
Acts 1997, No. 1142, §2; Acts 2014, No. 811, §24, eff. June 23, 2014.