Pennsylvania Code
Title 55 - HUMAN SERVICES
Part I - Department of Human Services
Subpart E - Home and Community-based Services
Chapter 52 - LONG-TERM LIVING HOME AND COMMUNITY-BASED SERVICES
Subchapter D - PROVIDER DISQUALIFICATION
Section 52.63 - Provider misutilization and abuse
Current through Register Vol. 54, No. 12, March 23, 2024
(a) If the Department's audit, financial review or monitoring indicates that a provider has been billing for services in a manner inconsistent with this chapter, unnecessary or inappropriate to a participant's needs, or contrary to customary standards of practice, the Department will notify the provider in writing that payment on all invoices will be delayed or suspended for a period not to exceed 120 days pending a review of billing and service patterns.
(b) A provider may have its invoices reviewed prior to payment.
(c) A provider's records may be reviewed.
(d) A provider may be required to submit a written explanation of billing practices.
