New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 515 - Provider Sanctions
Section 515.7 - Immediate sanctions

Universal Citation: 18 NY Comp Codes Rules and Regs § 515.7

Current through Register Vol. 46, No. 39, September 25, 2024

(a) Notwithstanding any provision of this Title to the contrary, the department, upon notice to the person, may take immediate action under this section.

(b) Upon receiving notice of an indictment which charges a person with committing an act which would be a felony under the laws of New York and which relates to or results from:

(1) the furnishing or billing for medical care, services or supplies; or

(2) participation in the performance of management or administrative services relating to furnishing medical care, services or supplies, the department may immediately exclude the person and any affiliates, and may continue the exclusion for 90 days following receipt of notice of the disposition of the indictment.

(1) the furnishing of or billing for medical care, servies or supplies; or

(d) Upon determining that the public health or welfare or the health or welfare of a recipient would be imminently endangered by the continued participation of any person in the program, the department may immediately exclude the person and any affiliates until the conditions giving rise to the exclusion have been corrected or a further investigation determines that there is insufficient evidence to support a continued exclusion.

(e) Upon receiving notice that a person has been found to have violated a State or Federal statute or regulation pursuant to a final decision or determination of an agency having the power to conduct the proceeding and after an adjudicatory proceeding has been conducted, in which no appeal is pending, or after resolution of the proceeding by stipulation or agreement, and where the violation resulting in the final decision or determination would constitute an act described as professional misconduct or unprofessional conduct by the rules or regulations of the State Commissioner of Education or the State Board of Regents, or an unacceptable practice under this Part, or a violation of article 33 of the Public Health Law, the department may immediately sanction the person and any affiliate.

(f) Where the department is authorized to exclude a person under this section, it may impose a less severe sanction, if a lesser sanction would be in the best interest of the program.

(g) Appeals.

(1) A person sanctioned under this section is not entitled to an administrative hearing, but may, within 30 days of the date of the notice, submit written arguments and documentation on the following issues:

(i) whether the determination was based upon a mistake of fact;

(ii) whether any crime charged in an indictment, or any conviction of a crime, resulted from furnishing or billing for medical care, services or supplies; and

(iii) whether the sanction imposed was reasonable.

(2) Within 45 days of receiving written arguments or documentation in response to an immediate sanction, the department will review the determination and notify the person sanctioned of the results of that review. After the review, the determination to immediately sanction the person may be affirmed, reversed or modified, in whole or in part.

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