10A NCAC 22F .0302        INVESTIGATION

(a)  Abusive practices shall be investigated according to the provisions of Rule .0202 of this Subchapter.

(b)  A Provider Summary Report shall be prepared by the investigative unit furnishing the full investigative findings of fact, conclusions, and recommendations.

(c)  The Division shall review the findings, conclusions, and recommendations and make a tentative decision for disposition of the case from among the following administrative actions:

(1)           To place provider on probation with terms and conditions for continued participation in the program.

(2)           To recover in full any improper provider payments.

(3)           To negotiate a financial settlement with the provider.

(4)           To impose remedial measures to include a monitoring program of the provider's Medicaid practice terminating with a "follow‑up" review to ensure corrective measures have been introduced.

(5)           To issue a warning letter notifying the provider that he must not continue his aberrant practices or he will be subject to further division actions.

(6)           To recommend suspension or termination.

(d)  The tentative decision shall be subject to the review procedures described in Section .0400 of this Subchapter.

(e)  If the investigative findings show that the provider is not licensed or certified as required by federal and state law, then the provider cannot participate in the North Carolina State Medical Assistance Program (Medicaid).


History Note:        Authority G.S. 108A‑25(b); 42 C.F.R. 455.14; 42 C.F.R. 455.15;

Eff. April 15, 1977;

Readopted Eff. October 31, 1977;

Amended Eff. July 1, 1988; May 1, 1984.