(a) The department may terminate a program rate if any of the following conditions are met:
(1) The department determines that, based upon the findings of a hearing officer, a rate application or information submitted by a provider was fraudulently submitted to the department.
(2) A provider is failing to provide services in accordance with the standards associated with its paid rate or in accordance with its program statement.
(3) A provider with an outstanding sustained overpayment incurs a second sustained overpayment, and is unable to repay the sustained overpayments.
(4) A provider has a sustained overpayment that represents 100 percent of a provider’s annual rate reimbursement.
(5) A provider has a sustained overpayment and has failed to timely submit its payments on more than three occasions in a 12-month period.
(b) This chapter shall not be construed to affect the department’s authority under other provisions of law for collection of provider sustained overpayments.
(Amended by Stats. 2015, Ch. 773, Sec. 101. (AB 403) Effective January 1, 2016.)