Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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55 Pa. Code § 1101.42a. Policy clarification regarding physician licensure—statement of policy.

§ 1101.42a. Policy clarification regarding physician licensure—statement of policy.

 (a)  To participate in the MA Program, a physician shall have and maintain a current license.

   (1)  Services rendered, ordered, arranged for or prescribed for MA recipients by a physician whose license to practice medicine has expired are not eligible for payment under the MA Program.

   (2)  Refer to §  1101.42 (relating to prerequisites for participation) and 49 Pa. Code Chapters 16, 17 and 25 (relating to State Board of Medicine—general provisions; State Board of Medicine—medical doctors; and State Board of Osteopathic Medicine) for additional requirements.

   (3)  The Department intends to periodically monitor the expiration of medical licenses to ensure compliance with MA regulations.

 (b)  The Department will initiate action to recover monies from a physician for one or both of the following:

   (1)  Medical services billed directly by the physician during the period in which his license is expired.

   (2)  Services ordered, arranged for or prescribed by the physician whose license has expired, including the services of other providers such as laboratories, radiologists, pharmacies, inpatient and outpatient hospitals and nursing homes that bill the Department for the ordered, arranged or prescribed services.

 (c)  A physician may not bill the recipient or another provider/person for services for which the Department has requested restitution.

 (d)  If the physician decides to eventually renew his license, the amount collected for services rendered, ordered, arranged for or prescribed during the unlicensed period will not be returned, and restitution requested shall be paid before reinstatement into the MA Program is considered.

Source

   The provisions of this §  1101.42a adopted September 1, 1989, effective immediately, retroactively applicable to July 1, 1988, 19 Pa.B. 3762.

Cross References

   This section cited in 55 Pa. Code §  1121.41 (relating to participation requirements); 55 Pa. Code §  1123.41 (relating to participation requirements); 55 Pa. Code §  1127.41 (relating to participation requirements); 55 Pa. Code §  1128.41 (relating to participation requirements); 55 Pa. Code §  1141.41 (relating to participation requirements); 55 Pa. Code §  1142.41 (relating to participation requirements); 55 Pa. Code §  1143.41 (relating to participation requirements); 55 Pa. Code §  1144.41 (relating to participation requirements); 55 Pa. Code §  1149.41 (relating to participation requirements); and 55 Pa. Code §  1251.41 (relating to participation requirements).



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