(a) The executive commissioner, in consultation with the office of inspector general, shall adopt rules establishing criteria for determining enforcement and punitive actions regarding a provider who violated state law, program rules, or the provider’s Medicaid provider agreement.
(b) The rules must include:
(1) direction for categorizing provider violations according to the nature of the violation and for scaling resulting enforcement actions, taking into consideration:
(A) the seriousness of the violation;
(B) the prevalence of errors by the provider;
(C) the financial or other harm to this state or recipients resulting or potentially resulting from those errors; and
(D) mitigating factors the office of inspector general determines appropriate; and
(2) a specific list of potential penalties, including the amount of the penalties, for fraud and other Medicaid violations.

Text of section effective on April 01, 2025