Pennsylvania Code & Bulletin

• No statutes or acts will be found at this website.

The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

55 Pa. Code § 1249.81. Provider misutilization.


§ 1249.81. Provider misutilization.

 Providers determined to have billed for service inconsistent with MA Program regulations, to have provided services outside the scope of customary standards of medical practice, or to have otherwise violated the standards set forth in provider agreement, are subject to the sanctions described in Chapter 1101 (relating to general provisions).


   The provisions of this §  1249.81 adopted December 6, 1980, effective December 1, 1980, 10 Pa.B. 4618.



   The provisions of this Appendix A adopted December 6, 1980, effective December 1, 1980, 10 Pa.B. 4618; reserved December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial page (75126).

No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.