Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 83k - Administrative Sanctions to be Invoked Against Vendors and/or Providers of Goods and Services Under the Title XIX (Medicaid) Program › Section 17-83k-1 - General statement

Current through July 10, 2024
(a)
General
			 statement.
Section 17-83k of the General Statutes provides for
			 administrative sanctions against vendors of goods or services performed for or
			 sold to beneficiaries under the medicare program, medicaid program, aid to
			 families with dependent children program, state supplement to the federal
			 supplemental security income program, or any federal or state energy assistance
			 program or general assistance program, including suspension or termination from
			 said programs. This act also provides for department notification of the proper
			 professional society and licensing agency of any violation thereof.
The following are policies and procedures for Administrative
				Sanctions to be imposed against vendors or providers of goods or services
				performed for or sold to beneficiaries under said programs for violations
				including, but not limited to, those hereinafter set forth.
(b)
Definitions
(1) 'Vendor' and 'provider' mean any person
			 acting on his own behalf or on behalf of an entity and any entity furnishing
			 goods or services.
(2) 'The
			 commissioner' means the commissioner or his duly authorized
			 representative.
(3) 'Suspension'
			 means limiting program participation of vendors who, although not convicted of
			 program-related crimes, are found by the department to have violated rules,
			 regulations, standards, and/or laws governing said program.
(4) 'Termination' means foreclosing program
			 participation by vendors who have been convicted of a crime involving program
			 participation.
(5) 'Convicted'
			 means that a judgment of conviction has been entered by a federal, state, or
			 local court, regardless of the plea upon which it was based or whether an
			 appeal from that judgment is pending.
(6) 'Violations' are (1) false statements of
			 representations knowingly and willfully made or caused to be made for the
			 purpose of claiming or determining payment, or (2) services furnished or
			 ordered in excess of the recipient's need, or (3) failure to adhere to
			 conditions of vendor participation in the program.
(7) 'Ownership or control interest' means a
			 person or corporation that:
(A) Has an
			 ownership interest totalling 5 percent or more in a disclosing
			 entity;
(B) Has an indirect
			 ownership interest equal to 5 percent or more in a disclosing entity;
(C) Has a combination of direct and indirect
			 ownership interests equal to 5 percent or more in a disclosing
			 entity;
(D) Owns an interest of 5
			 percent or more in any mortgage, deed of trust, note, or other obligation
			 secured by the disclosing entity if that interest equals at least 5 percent of
			 the value of the property or assets of the disclosing entity;
(E) Is an officer or director of a disclosing
			 entity that is organized as a corporation; or
(F) Is a partner in a disclosing entity that
			 is organized as a partnership.