Rhode Island General Laws 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 fraud control unit of the attorney general’s office has been denied reasonable access to information by a provider that 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.
Terms Used In Rhode Island General Laws 40-8.2-21
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Executive office: means the executive office of health and human services, the agency designated by state law and the Medicaid state plan as the Medicaid single state agency. See Rhode Island General Laws 40-8.2-2
- Fraud: Intentional deception resulting in injury to another.
- Medicaid fraud control unit: means a duly certified Medicaid fraud control unit under federal regulation authorized to perform those functions as described by § 1903(q) of the Social Security Act, Rhode Island General Laws 40-8.2-2
- Provider: means any individual, individual medical vendor, firm, corporation, professional association, partnership, organization, or other legal entity that provides goods or services under the Rhode Island Medicaid program, or the employee of any person or entity who, on his or her own behalf, or on the behalf of his or her employer, knowingly performs any act or is knowingly responsible for an omission prohibited by this chapter. See Rhode Island General Laws 40-8.2-2
- Rhode Island Medicaid program: means a state-administered, medical assistance program that is funded by the state and federal governments under Title XIX and Title XXI of the U. See Rhode Island General Laws 40-8.2-2
(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 that seek to remedy the conditions that 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.