OAR 333-004-3200: Grounds for Agency Sanctions; Sanctions

(1) The following may result in the imposition of a sanction against an agency: (a) Interference with the investigation of health care fraud; (b) Conviction for unlawfully manufacturing, distributing, prescribing, or dispensing a controlled substance; (c) An action by a state licensing authority relating to a provider's professional competence, professional conduct, or financial integrity, that results in the provider either: (A) Having their license suspended or revoked; or (B) Surrendering the license while a formal disciplinary proceeding was pending before a licensing authority. (d) Suspension or exclusion from participation in a federal or state-administered health care program for reasons related to professional competence, professional performance, or other reason; (e) Threatening, intimidating or harassing clients or their relatives in an attempt to influence payment rates or affect the outcome of disputes between the provider and the RH Program; (f) Participation in collusion that resulted in an inappropriate money flow between the parties involved, for example, referring clients unnecessarily to another provider; (g) For claims paid using CCare funds, any sanctions outlined in OAR 410-120-1400 (HSD Medicaid Programs, General Administrative Rules); (h) Unauthorized or unlawful disclosure of client information; and (i) Failure to comply with these rules. (2) The RH Program shall consider the following factors in determining whether to issue a sanction and the sanction to be imposed: (a) Nature of the violation or offense; (b) Extent of the violations by the agency; (c) History of prior violations by the agency; (d) Prior imposition of sanctions; (e) Prior notification of compliance findings; and (f) Cooperation with an investigation. (3) Sanctions may include one or more of the following: (a) Termination of certification; (b) Imposition of a Corrective Action Plan; (c) A requirement to attend provider education sessions at the expense of the sanctioned agency; (d) A requirement that payment for certain services are made only after the RH Program has reviewed documentation supporting the services; and (e) For claims paid using CCare funds, any action authorized under OAR 410-120-1460 (HSD Provider Sanctions).