Unrelated crimes generally would not trigger provider program sanctions

The director may not sanction a provider solely for certain criminal offenses or attempted offenses. It covers offenses that are not fraud, are not among certain federal health care offenses, and are unrelated to the provider's health care practice. The limit does not apply when federal law requires action, as long as the action is no stricter than federal law requires. It also does not apply to specified crimes involving health facilities or mental health services.

The director must allow some people with past participation sanctions to return to the program. This applies to people charged with a program participation sanction for an offense unrelated to their health care practice. The director may deny return if federal law requires it, the offense is one specified under state health or mental health law, or another valid sanction supports the denial. The rule applies to charges made before the effective date of the act that adds this subsection.

The department's approved written claim policies do not count as misrepresentation under the specified claim rule. The rule covers claims that misstate the services provided, service dates, recipient, practitioner, or actual provider. The department must issue the policies, and the director or a designee must approve them.