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 515.8 - Mandatory exclusions
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 515.8
Current through Register Vol. 46, No. 12, March 20, 2024
(a) Notwithstanding any provision of this Title to the contrary, the following persons are immediately excluded from participation in the medical assistance program:
(1) a person who is excluded or
terminated from participation in the Federal Medicare program;
(2) a health maintenance organization (HMO)
furnishing services under a waiver granted pursuant to Federal law when:
(i) any affiliate of such HMO or person with
whom the HMO has a significant business transaction is convicted of a criminal
offense under section 1128 of the Federal Social Security Act;
(ii) any affiliate of such HMO or person with
whom the HMO has a significant business transaction is assessed civil money
penalties under section 1128A of the Federal Social Security Act; or
(iii) such HMO has been excluded from the
Federal Medicare program or any states' health care program.
(b) Appeals. 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 regarding whether the determination was based upon mistake of fact.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
