Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part I - Administration › Subpart 5 - Provider Fraud and Recovery › Chapter 41 - Surveillance and Utilization Review Subsystem (SURS) › Subchapter D - Conduct › Section I-4149 - Scope of a Violation

Current through Register Vol. 50, No. 6, June 20, 2024
A. Violations
					 may be imputed in the following manner.
1.
					 The conduct of a provider-in-fact is always attributable to the provider. The
					 conduct of a managing employee is always attributable to the provider and
					 provider-in-fact.
2. The conduct of
					 an agent of the provider, billing agent, or affiliate of the provider may be
					 imputed to the provider or provider-in-fact if the conduct was performed within
					 the course of his duties for the provider or was effectuated by him with the
					 knowledge or approval of the provider or provider-in-fact.
3. The conduct of any person or entity
					 operating on behalf of a provider may be imputed to the provider or
					 provider-in-fact.
4. The provider
					 and provider-in-fact are responsible for the conduct of any and all officers,
					 employees, contractors, or agents of the provider. The conduct of these persons
					 or entities may be imputed to the provider or provider-in-fact.
5. A violation under one Medicaid number may
					 be extended to any and all Medicaid numbers held by the provider or
					 provider-in-fact or which may be obtained by the provider or
					 provider-in-fact.
6. Recoupments or
					 recoveries may be made from any payments or reimbursement made under any and
					 all provider numbers held by or obtained by the provider or
					 provider-in-fact.
7. Any sanctions,
					 including recovery or recoupment, imposed on a provider or provider-in-fact
					 shall remain in effect until its terms have been satisfied. Any person or
					 entity who purchases, merges or otherwise consolidates with a provider or
					 employs or affiliates a provider-in-fact, agent of the provider or affiliate of
					 a provider who has had sanctions imposed on it under this regulation assumes
					 liability for those sanctions, if the person or entity knew or should have
					 known about the existence of the sanctions, and may be subject to additional
					 sanctions based on the purchase, merger, consolidation, affiliation or
					 employment of the sanctioned provider or provider-in-fact.
8. A provider or provider-in-fact who refers
					 a recipient to another for the purpose of providing a good, service, or supply
					 to a recipient may be held responsible for any or all over-billing by the
					 person to whom the recipient was referred provided the referring provider or
					 person knew or should have known that such over-billing was likely to
					 occur.
9. Providers which are legal
					 entities, i.e., clinics, corporations, HMOs, PPOs, etc., may be held jointly
					 liable for the repayment or recoupment of any person within that legal entity
					 if it can be shown that the entity received any economic benefit related to the
					 overpayment.
10. Withholdings of
					 payments imposed on a provider may be extended to any or all provider numbers
					 held or obtained by that provider or any provider-in-fact of that
					 provider.
11. A recoupment, fine,
					 recovery or penalty, which is owed to the department by a provider or
					 provider-in-fact, can be imputed to a group and/or entity to which the provider
					 or provider-in-fact is linked.