Vermont Administrative Code §13 170 710

“Violations of provider responsibility under the Agency of Human Services regulations”

The Department for Children and Families may impose sanctions against a provider for:

• Submitting  a false claim for care or services;
• Submitting false information to obtain greater compensation than what the provider is legally entitled;
• Submitting false information to meet prior authorization requirements;
• Submitting a false application to obtain provider status;
• Failing to disclose to the department records of services provided to Medicaid beneficiaries and records of payments received for those services;
• Over-utilizing the Medicaid program by inducing, furnishing or otherwise causing a beneficiary to receive care and services not required by the beneficiary.

Sanctions include:

• Exclusion from participation in the Medicaid program;
• Suspension from participation in the Medicaid program;
• Deferment or offsetting of payments to a provider;
• Transfer to a closed-end provider agreement not to exceed 12 months;
• Mandatory attendance at provider information sessions;
• Required prior authorization of service;
• 100 percent review of the provider's claims prior to payment; or
• Recovery of overpayment by offset or civil action, including recovery of reasonable interest and costs.