Rhode Island General Laws
Chapter 40-8.2 - Medical Assistance Fraud
Section 40-8.2-21. - Suspension of payments to a provider.

§ 40-8.2-21. Suspension of payments to a provider.
(a) The executive office of health and human services may issue a suspension of payments order if:
(1) The provider does not meet certification requirements of the Rhode Island Medicaid program; or
(2) The Rhode Island Medicaid program has been unable to collect (or make satisfactory arrangements for the collection of) amounts due on account of overpayments to any provider; or
(3) The office of program integrity and/or the Medicaid fraud control unit of the attorney general’s office has been unable to obtain, from a provider, the data and information necessary to enable it to determine the existence or amount (if any) of the overpayments made to a provider; or
(4) The office of program integrity or the Medicaid fraud control unit of the attorney general’s office has been denied reasonable access to information by a provider that pertains to a patient or resident of a long-term residential-care facility or to a former patient or resident of a long-term residential-care facility; or
(5) The office of program integrity and/or the Medicaid fraud control unit of the attorney general’s office has been denied reasonable access to data and information by the provider for the purpose of conducting activities as described in § 1903(g) of the Social Security Act, 42 U.S.C. § 1396b(g); or
(6) The office of program integrity has been presented with reliable evidence that the provider has engaged in fraud or willful misrepresentation under the Medicaid program.
(b) Any such order of the executive office of health and human services may cease to be effective at such time as the office of program integrity is satisfied that the provider is participating in substantial negotiations that seek to remedy the conditions that gave rise to its order of suspension of payments, or that amounts are no longer due from the provider or that a satisfactory arrangement has been made for the payment of the provider or that a satisfactory arrangement has been made for the payment by the provider of any such amounts.
History of Section.P.L. 1982, ch. 424, § 1; P.L. 1989, ch. 137, § 1; P.L. 2015, ch. 141, art. 5, § 12.

Structure Rhode Island General Laws

Rhode Island General Laws

Title 40 - Human Services

Chapter 40-8.2 - Medical Assistance Fraud

Section 40-8.2-1. - Short title.

Section 40-8.2-2. - Definitions.

Section 40-8.2-3. - Prohibited acts.

Section 40-8.2-4. - Statute of limitations.

Section 40-8.2-5. - Civil remedy.

Section 40-8.2-6. - Civil actions brought by attorney general on behalf of persons injured by violations of chapter.

Section 40-8.2-7. - False statements made to gain certification.

Section 40-8.2-8. - Acts of officers, directors, representatives, or agents acting within the scope of their authority.

Section 40-8.2-9. - Damages for overcharges.

Section 40-8.2-10. - Other civil remedies and criminal penalties.

Section 40-8.2-11. - Barring or suspending participation in program.

Section 40-8.2-12. - Injunctive relief and civil penalties.

Section 40-8.2-13. - Consent decrees.

Section 40-8.2-14. - Investigative demand.

Section 40-8.2-15. - Consistency with Confidentiality of Health Care Information Act.

Section 40-8.2-16. - Rendering services to recipients after suspension or revocation of certification.

Section 40-8.2-17. - Stays and review of revocation orders.

Section 40-8.2-18. - Filing and enforcement of administrative decision.

Section 40-8.2-19. - Certification as a provider — Revocation or suspension of certification.

Section 40-8.2-20. - Eligibility for certification.

Section 40-8.2-21. - Suspension of payments to a provider.

Section 40-8.2-22. - Interest on overcharges.

Section 40-8.2-23. - Use of Medicaid funds for anti-union purposes prohibited.