DHS 106.08(2)(c) (c) For conduct resulting in repeated recoveries under s. DHS 108.02 (9);

DHS 106.08(2)(d) (d) For non-compliance with one or more certification requirement applicable to the type of provider under ch. DHS 105;

DHS 106.08(2)(e) (e) For interference with recipient rights specified under ch. DHS 104; or

DHS 106.08(2)(f) (f) For refusal or repeated failure to comply with one or more requirement specified under this chapter.

DHS 106.08(3) (3) The department may impose one or more of the following intermediate sanctions for a violation listed under sub. (2):

DHS 106.08(3)(a) (a) Referral to the appropriate peer review organization, licensing authority or accreditation organization;

DHS 106.08(3)(b) (b) Transfer to a provider agreement of limited duration which also may stipulate specific conditions of participation;

DHS 106.08(3)(c) (c) Requiring prior authorization of some or all of the provider’s services;

DHS 106.08(3)(d) (d) Review of the provider’s claims before payment;

DHS 106.08(3)(e) (e) Restricting the provider’s participation in the MA program;

DHS 106.08(3)(f) (f) Requiring an independent audit of the provider’s practices and records, with the findings and recommendations to be provided to the department;

DHS 106.08(3)(g) (g) Requiring the provider to perform a self-audit following instructions provided by the department; and

DHS 106.08(3)(h) (h) Requiring the provider, in a manner and time specified by the department, to correct deficiencies identified in a department audit, independent audit or department survey or inspection.

DHS 106.08(4) (4) In determining the appropriate sanction or sanctions to be applied to a non-compliant provider and the duration of the sanction or sanctions, the department shall consider:

DHS 106.08(4)(a) (a) The seriousness and extent of the offense or offenses;

DHS 106.08(4)(b) (b) History of prior offenses;

DHS 106.08(4)(c) (c) Prior sanctions;

DHS 106.08(4)(d) (d) Provider willingness and ability to comply with MA program requirements;

DHS 106.08(4)(e) (e) Whether a lesser sanction will be sufficient to remedy the problem in a timely manner;

DHS 106.08(4)(f) (f) Actions taken or recommended by peer review organizations, licensing authorities and accreditation organizations;

DHS 106.08(4)(g) (g) Potential jeopardy to recipient health and safety and the relationship of the offense to patient care; and

DHS 106.08(4)(h) (h) Potential jeopardy to the rights of recipients under federal or state statutes or regulations.

DHS 106.08 History History: Cr. Register, February, 1993, No. 446, eff. 3-1-93; corrections in (2) (c), (d) and (e) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 106.09 DHS 106.09 Departmental discretion to pursue monetary recovery.

DHS 106.09(1) (1) Nothing in this chapter shall preclude the department from pursuing monetary recovery from a provider at the same time action is initiated to impose sanctions provided for under this chapter.

DHS 106.09(2) (2) The department may pursue monetary recovery from a provider of case management services or community support program services when an audit adjustment or disallowance has been attributed to the provider by the federal health care financing administration or the department. The provider shall be liable for the entire amount. However, no fiscal sanction under this subsection shall be taken against a provider unless it is based on a specific policy which was:

DHS 106.09(2)(a) (a) In effect during the time period being audited; and

DHS 106.09(2)(b) (b) Communicated to the provider in writing by the department or the federal health care financing administration prior to the time period audited.

DHS 106.09 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, February, 1988, No. 386, eff. 3-1-88; emerg. am. (2) (intro.), eff. 1-1-90; am. (2) (intro.), Register, September, 1990, No. 417, eff. 10-1-90; renum. from HSS 106.075, Register, February, 1993, No. 446, eff. 3-1-93.