10.09.02.09

.09 Cause for Suspension or Removal and Imposition of Sanctions.

A. If the Department determines that a provider, physician, any agent or employee of the provider, or any person with an ownership interest in the provider has failed to comply with applicable federal or State laws or regulations, the Department may initiate one or more of the following actions against the responsible party:

(1) Suspension from the Program;

(2) Withholding of payment by the Program;

(3) Removal from the Program;

(4) Disqualification from future participation in the Program, either as a provider or as a person providing services for which Program payment will be claimed.

B. If the Secretary of Health and Human Services suspends or removes a physician from participation in Medicare, the Department will take similar action.

C. The Department may consult with the Peer Review Committee of the Medical and Chirurgical Faculty of Maryland. The Department will give the findings and recommendations of this group consideration.

D. The Department will give the provider reasonable notice of its intention to impose sanctions. In the written notice the Department will establish the effective date and the reasons for the proposed action, and advise the provider of the right to appeal.

E. A provider who voluntarily withdraws from the Program, or is removed or suspended from the Program according to this regulation, shall notify recipients, before rendering additional services, that the provider no longer honors Medical Assistance cards.

F. If the Department determines that a provider participating in the Program as a case manager has violated any provision of the agreement executed under the terms of Regulation .03A(2) of this chapter, the Program may suspend or disqualify the provider from participating as a case manager without otherwise restricting the provider's participation as a physician.