Source: https://www.bafirm.com/practice-areas/qui-tam-litigation/federal-state-county-and-city-acts/louisiana-medical-assistance-programs-integrity-law/
Timestamp: 2019-04-21 02:40:51+00:00

Document:
This Part may be cited as the “Medical Assistance Programs Integrity Law”.
Added by Acts 1997, No. 1373, § 1.
Added by Acts 1997, No. 1373, § 1. Amended by Acts 2011, No. 185, § 1.
D. (1) Unless the provider agreement is terminated by the secretary for cause as provided in Paragraph (2) of this Subsection, a health care provider agreement shall be effective for a stipulated period of time, shall be terminable by either party thirty days after receipt of written notice, and shall be renewable by mutual agreement.
Added by Acts 1997, No. 1142, § 2.
(1) At the time of signing the provider agreement, have in his possession a valid professional or facility license or certificate pertinent to the goods, services, or supplies being provided, as required by applicable federal and state laws and rules, and maintain such license or certificate in good standing with the department throughout the effective period of the provider agreement.
(10)(a) Accept payment from the medical assistance programs as payment in full, and prohibit the health care provider from billing or collecting any additional amount from the recipient or the recipient’s responsible party except, and only to the extent the department permits or requires, a co-payment, coinsurance, or a deductible to be paid by the recipient for the goods, services, or supplies provided.
(b) The payment-in-full policy shall not apply to goods, services, or supplies provided to a recipient if the goods, services, or supplies are not covered by the medical assistance programs or the recipient is determined not to be covered by medical assistance programs.
(11) Agree to be subject to claims review.
B. A provider agreement shall provide that, if the health care provider sells or transfers a business interest or practice that substantially constitutes the entity named as the health care provider in the provider agreement, or sells or transfers a facility that is of substantial importance to the entity named as the health care provider in the provider agreement, the health care provider shall maintain and make available to the department medical assistance programs-related records that relate to the sale or transfer of the business interest, practice, or facility in the same manner as though the sale or transaction had not taken place, unless the health care provider enters into an agreement with the purchaser of the business interest, practice, or facility to fulfill this requirement and provides a copy of this agreement to the department.
(1) Make payment timely at the established rate for goods, services, or supplies furnished to a recipient by the health care provider upon receipt of a properly completed and properly supported claim.
(2) Require certification on the claim form that the goods, services, or supplies have been completely furnished to a recipient eligible to receive the goods, services, or supplies and that, with the exception of those goods, services, or supplies specified by the department, the amount billed does not exceed the health care provider’s usual and customary charge for the same goods, services, or supplies.
(3) Not demand repayment from the health care provider in any instance in which the medical assistance programs overpayment is attributable to error of the department in the determination of eligibility of a recipient.
(1) Enroll the applicant as a Medicaid provider.
(2) Deny the application if, based on the grounds listed in R.S. 46:437.14, the secretary determines that it is in the best interest of the medical assistance programs to do so, specifying the reasons for denial.
Added by Acts 1997, No. 1142, § 2. Amended by Acts 2008, No. 139, § 1.
(3) “Substandard quality” in reference to services applicable to medical care as used in this Subsection shall mean substandard as to the appropriate standard of care as used to determine medical malpractice, including but not limited to the standard of care provided in R. S. 9:2794.
Added by Acts 1997, No. 1373, § 1. Amended by Acts 2007, No. 14, § 1, eff. June 18, 2007; Acts 2009, No. 426, § 1; Acts 2011, No. 185, § 1.
(2) Except as limited by this Section, any person who is found to have violated R.S. 46:438.3shall be subject to a civil fine in an amount not to exceed three times the amount of actual damages sustained by the medical assistance programs as a result of the violation.
Added by Acts 1997, No. 1373, § 1. Amended by Acts 2007, No. 14, § 1, eff. June 18, 2007; Acts 2011, No. 185, § 1.
H, I. Repealed by Acts 2011, No. 185, § 2.
Added by Acts 1997, No. 1373, § 1. Amended by Acts 2009, No. 426, § 1; Acts 2011, No. 185, § 1.
C. Repealed by Acts 2011, No. 185, § 2.
Added by Acts 1997, No. 1373, § 1. Amended by Acts 2009, No. 426, § 1.
Added by Acts 1997, No. 1373, § 1. Amended by Acts 2008, No. 712, § 1, eff. July 1, 2009.

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