Current through Register Vol. 48, No. 12, March 22, 2024
a) Reporting of
Illegal Acts
1) Any entity involved in the
administration of the CCP or in the provision of CCP services, upon receipt of
any report of or evidence of an improper or unlawful act having been committed
by their employees, for the purpose of illegally obtaining money or extorting
payment for care, goods, services or supplies, shall immediately:
A) inform the appropriate law enforcement
authorities; and
B) report to the
Department, including any documentation which may have been obtained, regarding
any alleged theft or missing items having value over $50.00 or such unlawful
activities which result in a police report.
2) Failure of a CCU or vendor to make a
report to the appropriate law enforcement authorities and to the Department
shall result in contract action as delineated in Section
240.1665
for vendors and Subpart N for CCUs.
b) Department staff, designated by the
Director, shall make an immediate investigation of the alleged improper or
unlawful acts. When the result of the Department's investigations produces
evidence that indicates CCU/vendor improprieties or unlawful activities, the
Department shall make an immediate report to the appropriate law enforcement
authorities.
c) Any entity or
individual provider involved in the administration/provision of CCP services
shall not bill the Department for more services than were provided to or on
behalf of CCP participants.
1) Anyone in
receipt of information that the Department has been improperly billed for
services shall report the incident to the Department and provide the Department
with any report/documentation that may have been obtained.
2) Department staff, designated by the
Director, shall complete an immediate review of the report.
3) If the Department determines that the
allegations in the report are factual, based upon the above cited-review, the
Department will advise the CCU or vendor in writing regarding what action shall
be taken (e.g., no action, if in the best interests of the participant;
suspension; termination). (See Sections
240.1399
and
240.1665
for vendors and Subpart N for CCUs.)
d) Any entity or individual involved in the
provision of CCP services shall cooperate with and provide assistance to the
Department/law enforcement authorities in any investigation of any alleged
illegal or criminal act. (See Section
240.1665
for vendors and Subpart N for CCUs.)
