New York Codes, Rules and Regulations › Title 9 - EXECUTIVE DEPARTMENT › Subtitle KK - Program for Elderly Pharmaceutical Insurance Coverage › Part 9800 - Enrollment Of Pharmacies › Section 9800.5 - Denial of an application

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
				determining whether to enter into a contract with a pharmacy-applicant, the
				following factors shall be grounds for denial of an application:
(1) any false representation or omission of
				any material fact in making the application;
(2) any previous or current suspension,
				exclusion or involuntary withdrawal from participation in the medical
				assistance program or the Medicaid program of any other state of the United
				States or from participation in any other governmental or private medical
				insurance program, including but not limited to Medicare, workers'
				compensation, physically handicapped children's program and rehabilitation
				services;
(3) the receipt of, but
				not having made restitution for, a Medicaid or Medicare overpayment, as
				determined to have been made pursuant to a final decision or determination of
				an agency having the powers to conduct the proceeding and after an adjudicatory
				proceeding in which no appeal is pending or after resolution of the proceeding
				by stipulation or agreement; however, if a pharmacy-applicant has entered into
				a plan of restitution of such overpayment, an application may not be denied
				based solely on this factor unless the pharmacy-applicant has defaulted in
				repayment;
(4) any false
				representation or omission of a material fact in making application in any
				state of the United States for any license, permit, certificate or registration
				related to a profession or business;
(5) any previous failure to correct
				deficiencies in the operation of a business or enterprise after having received
				written notice of the deficiencies from a State or Federal licensing or
				auditing agency;
(6) any failure to
				supply further information concerning the application after receiving a written
				request for such further information;
(7) the submission of an application which
				conceals an ownership or control interest of any person who would otherwise be
				ineligible to participate;
(8) an
				outstanding indictment for, or prior conviction of, any crime relating to the
				furnishing of, or billing for, medical care, services or supplies, or which is
				considered an offense involving theft or fraud or an offense against public
				administration or against public health and morals;
(9) a prior finding by a licensing,
				certifying or professional standards board or agency of the violation of the
				standards or conditions relating to licensing or certification or as to the
				quality of services provided;
(10)
				the pharmacy-applicant's prior pattern or practices in furnishing medical care,
				services or supplies under any private or publicly funded program or policy of
				insurance; and
(11) any other
				factor having a direct bearing on the pharmacy-applicant's ability to provide
				high-quality pharmaceutical services to participants in the program, or to be
				fiscally responsible under the program, including actions by persons affiliated
				with the pharmacy-applicant.