Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

55 Pa. Code § 1126.81. Provider misutilization.


§ 1126.81. Provider misutilization.

 If the Department determines that a provider billed for services inconsistent with this chapter and Chapter 1101 (relating to general provisions), provided incorrect information on the billing invoice regarding a patient’s diagnosis or procedures performed during the period of hospitalization or otherwise violated the standards in the provider agreement, the provider is subject to the sanctions in Chapter 1101.

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