A person is subject to administrative actions or sanctions
if the person:
(1) reports costs of non-covered or non-chargeable
health care or administrative services, supplies, equipment, or other
unallowable expenses in a cost report;
(2) incorrectly apportions or allocates costs in a
cost report;
(3) reports costs of unallowable health care or administrative
services, supplies, or equipment as allowable costs in a cost report;
(4) reports costs of health care services, supplies,
or equipment that were not delivered to the recipient;
(5) reports costs of administrative services, supplies,
or equipment that were not actually incurred;
(6) engages in an arrangement between providers and
employees, related parties, independent contractors, suppliers, and/or
others that appear to be designed to overstate the costs to the program
through any device (such as commissions or fee splitting) or to siphon
off or conceal illegal profits;
(7) reports costs in a cost report that were not incurred,
that were incurred at a discount or lesser cost than that which was
reported, or that were attributable to non-program activities, other
enterprises, or personal expenses;
(8) manipulates or falsifies statistics that result
in overstatement of costs or avoidance of recoupment, including incorrectly
reporting square footage, hours worked, revenues received, or units
of service delivered;
(9) claims bad debts without first attempting to collect
payment;
(10) depreciates assets that have been fully depreciated
or sold, or uses an incorrect basis for depreciation;
(11) affiliates with, retains, or employs a person
excluded from participation in Medicare, Medicaid, or other HHS program
and includes the salary, fringe, overhead, or any other costs associated
with the excluded person within a cost report or any documents used
to determine a person's payment rate, a statewide payment rate, or
a fee;
(12) reports a cost above the cost actually paid to
a related party;
(13) reports a damage, cost, or penalty collected by
the OIG as an allowable expense in a cost report;
(14) minimizes or understates profits on a cost report;
(15) manipulates or understates profits on a cost report
in a manner that reduces the experience rebate that would have been
owing to the state;
(16) manipulates or falsifies supporting documentation
related to a cost report, including the use of market data rather
than actual expenses; or
(17) manipulates or falsifies any cost report supporting
documentation including medical loss statistics, annual statements,
encounter data, cash disbursement journal entries, or annual reports.
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