(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 No.
560-X-56-.19(2)
of this Section, such information shall be promptly reported to Medicaid's
Director of Provider Audit who shall insure 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 Medicaid Director of Provider
Audit, based upon such informal inquiry, determines that there is substantial
evidence that the preparer has engaged in conduct specified in Rule No.
560-X-56-.18, he 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
Director of Provider Audit with information which results in a determination by
the Director that the evidence of misconduct is insufficient to justify
suspension, the Director 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 Director of Provider Audit 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.
1. Notice. The
initial
notice from the Director of Provider Audit to the preparer will
describe with sufficient specificity to 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 No.
560-X-56-.19(3)(b)
l 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 Director of Provider
Audit. A response or correspondence from the preparer or his representative
shall be mailed to Director of Provider Audit, Alabama Medicaid Agency at the
Agency's current address.
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 related to Fair
Hearings. (Chapter 3 of the Alabama Medicaid Administrative Code.)
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 a hearing and the Commissioner of Medicaid may
make his or her determination without further proceedings.
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, unless the preparer has waived
his right to hearing, in which event there need be no recommendation by 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 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 No.
560-X-56-.18 of this code.
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