(3)
Determination of Eligibility.
(a) Upon
receipt by any Medicaid employee of information indicating that a Cost Report
Preparer may have engaged in conduct which could result in the refusal by
Medicaid to accept cost reports prepared by such preparer under Rule
560-X-42-.26 of this Section,
such information shall be promptly reported to Medicaid's Chief Auditor who
shall ensure that an informal inquiry is made regarding the reliability of such
information. Medicaid legal counsel and/or appropriate representatives of the
Attorney General's office shall be consulted, as deemed appropriate.
(b) Informal Inquiry.
1. If the Chief Auditor, based upon such
informal inquiry, determines that there is substantial evidence that the
preparer has engaged in conduct specified in Rule
560-X-42-.25, he/she will give
written notice to the preparer which will offer the preparer the opportunity to
refute such information or allegations. If the preparer fails to provide the
Chief Auditor with information which results in a determination by the Chief
Auditor that the evidence of misconduct is insufficient to justify suspension,
the Chief Auditor will, at the preparer's request, have a hearing arranged and
will have the preparer notified that such an administrative hearing will be
held with regard to the alleged misconduct.
2. Should the preparer fail to deny or
provide documentation or information to refute the allegations made against him
within thirty (30) days after the date of the mailing of the initial letter to
the preparer, such allegations will be deemed to be admitted, and the preparer
will have waived his right of hearing. The Chief Auditor will then notify the
preparer of his suspension under this rule.
3. The above-described hearing will be set
for a time no earlier than thirty (30) days after the date of the mailing of
the initial letter to the preparer.
(c) Procedures Related to Informal Inquiry
and Hearing.
1. Notice. The
initial notice from the Chief Auditor to the preparer
will describe with sufficient specificity the allegations being made against
him to allow him to respond to those allegations in a specific
manner.
2. The Notice of Hearing.
The notice of hearing to the preparer will repeat the allegations which
constitute the basis for the proceedings and state the date, time, and place of
the hearing. The hearing, as noted in Rule
560-X-42-.26(3)(b)(1)
above will be arranged only at the request of the preparer. Such notice shall
be considered sufficient if it fairly informs the preparer of the allegations
against him so that he is able to prepare his defense. Such notice may be
mailed to the preparer by first class or certified mail, addressed to him at
his last address known to the Chief Auditor. A response or correspondence from
the preparer or his representative shall be mailed to Chief Auditor, Alabama
Medicaid Agency.
3. Answer. No
written answer to the notice of hearing shall be required of the
preparer.
4. Hearing. The hearing
shall be conducted in accordance with Medicaid's Regulations (Chapter 560-X-3
of the
Alabama Medicaid Administrative Code) related
to Fair Hearings.
5. Failure to
Appear. If the preparer fails to appear at the hearing after notice of the
hearing has been sent to him, he shall have waived the right to be present. The
hearing officer may proceed with the conduct of the hearing and make his/her
recommendation to the Commissioner of Medicaid who may make his or her
determination.
6. Determination of
Ineligibility. The determination of the ineligibility of a Cost Report Preparer
to prepare Medicaid cost reports will lie solely with the Commissioner of
Medicaid. The Commissioner will make such determination after giving due
consideration to the written recommendation of the Hearing Officer.
7. Notification of Ineligibility. If the
determination of the Commissioner is that the preparer shall no longer be
eligible to prepare Medicaid cost reports, the preparer shall be notified in
writing, and the preparer shall thereafter not be eligible to prepare such
reports unless and until authorized by the Commissioner of Medicaid to do so.
Such a preparer shall IN NO EVENT be eligible to prepare such cost reports
during the two (2) year period immediately following his suspension. Any person
who acts as a Cost Report Preparer during his period of suspension shall not
thereafter be eligible to act as a Cost Report Preparer for a period of ten
(10) years from the date of his original suspension. Any provider who knowingly
allows a cost report to be prepared by a person who has been suspended under
this Section will be subject to having its provider agreement cancelled and
will be subject to the applicable penalties of Rule
560-X-42-.25 of this Code.
Author: Susan Mims