Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 7346 (November 25, 2023).

55 Pa. Code § 6210.109. Provider misutilization.

§ 6210.109. Provider misutilization.

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

Cross References

   This section cited in 55 Pa. Code §  6210.101 (relating to scope of claims review procedures).

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