Sec. 544.0052. RULES REGARDING ENFORCEMENT AND PUNITIVE ACTIONS. (a) The executive commissioner, in consultation with the office of inspector general, shall adopt rules establishing criteria for determining enforcement and punitive actions regarding a provider who violated state law, program rules, or the provider's Medicaid provider agreement. (b) The rules must include: (1) direction for categorizing provider violations according to the nature of the violation and for scaling resulting enforcement actions, taking into consideration: (A) the seriousness of the violation; (B) the prevalence of errors by the provider; (C) the financial or other harm to this state or recipients resulting or potentially resulting from those errors; and (D) mitigating factors the office of inspector general determines appropriate; and (2) a specific list of potential penalties, including the amount of the penalties, for fraud and other Medicaid violations.
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