§ 1121.81. Provider misutilization.
(a) A provider determined to have billed for services inconsistent with MA Program regulations, to have provided services outside the scope of customary standards of pharmaceutical practice, or to have otherwise violated the standards in the provider agreement, is subject to the sanctions described in Chapter 1101 (relating to general provisions).
(b) Where a provider is subject to subsection (a) or § 1101.77 (relating to enforcement actions by the Department), the pharmacist responsible for the violations, the owner of the provider at the time of the violation and a person owning 5% or more of shares of stock in the provider at the time of the violation shall be subject to preclusion from indirect participation in the MA Program for the same period as a sanction against the provider. No provider may participate or be enrolled in the MA Program while owned or operated by a person precluded from indirect participation. Ownership includes but is not limited to ownership of 5% or more of the corporate stock of the provider if the provider is incorporated.
Notes of Decisions
A provider pharmacy which permitted an unlicensed pharmacists assistant to fill and dispense prescriptions provided services outside the scope of customary standards of pharmaceutical practice subsection (a). Girard Prescription Center v. Department of Public Welfare, 496 A.2d 83 (Pa. Cmwlth. 1985); appeal granted 503 A.2d 930 (Pa. 1986).
There is no element of scienter in this section, which permits the Department of Public Welfare to impose sanctions on a provider pharmacy which has provided services outside the scope of customary standards of pharmaceutical practice. Girard Prescription Center v. Department of Public Welfare, 496 A.2d 83 (Pa. Cmwlth. 1985).
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