(a)
General
statement. Section 17-83k of the General Statutes provides for
administrative sanctions against vendors of goods or services performed for or
sold to beneficiaries under the medicare program, medicaid program, aid to
families with dependent children program, state supplement to the federal
supplemental security income program, or any federal or state energy assistance
program or general assistance program, including suspension or termination from
said programs. This act also provides for department notification of the proper
professional society and licensing agency of any violation thereof.
The following are policies and procedures for Administrative
Sanctions to be imposed against vendors or providers of goods or services
performed for or sold to beneficiaries under said programs for violations
including, but not limited to, those hereinafter set forth.
(b)
Definitions
(1) 'Vendor' and 'provider' mean any person
acting on his own behalf or on behalf of an entity and any entity furnishing
goods or services.
(2) 'The
commissioner' means the commissioner or his duly authorized
representative.
(3) 'Suspension'
means limiting program participation of vendors who, although not convicted of
program-related crimes, are found by the department to have violated rules,
regulations, standards, and/or laws governing said program.
(4) 'Termination' means foreclosing program
participation by vendors who have been convicted of a crime involving program
participation.
(5) 'Convicted'
means that a judgment of conviction has been entered by a federal, state, or
local court, regardless of the plea upon which it was based or whether an
appeal from that judgment is pending.
(6) 'Violations' are (1) false statements of
representations knowingly and willfully made or caused to be made for the
purpose of claiming or determining payment, or (2) services furnished or
ordered in excess of the recipient's need, or (3) failure to adhere to
conditions of vendor participation in the program.
(7) 'Ownership or control interest' means a
person or corporation that:
(A) Has an
ownership interest totalling 5 percent or more in a disclosing
entity;
(B) Has an indirect
ownership interest equal to 5 percent or more in a disclosing entity;
(C) Has a combination of direct and indirect
ownership interests equal to 5 percent or more in a disclosing
entity;
(D) Owns an interest of 5
percent or more in any mortgage, deed of trust, note, or other obligation
secured by the disclosing entity if that interest equals at least 5 percent of
the value of the property or assets of the disclosing entity;
(E) Is an officer or director of a disclosing
entity that is organized as a corporation; or
(F) Is a partner in a disclosing entity that
is organized as a partnership.
