Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT
Section 16.05.07.270 - MISCELLANEOUS CORRECTIVE ACTIONS
Current through August 31, 2023
The Department may take lesser action to investigate, monitor and correct suspected instances of fraud, abuse, over utilization, and other misconduct as provided in this rule. (3-17-22)
01. Issuance of a Warning. Issuance of a warning letter describing the nature of suspected violations, and requesting an explanation of the problem and a warning that additional action may be taken if the action is not justified or discontinued. (3-17-22)
02. Review. Prepayment review of all or selected claims submitted by the provider with notice that claims failing to meet written guidelines will be denied. (3-17-22)
03. Referral. Referral to state licensing boards for review of quality of care and professional and ethical conduct. (3-17-22)
