Section 51.27. Misuse and abuse of funds and damage of participant’s property

(a) A provider’s records and invoices may be reviewed and the provider may be required to provide a written explanation of billing practices during an audit, fiscal review or provider monitoring.

(b) If the Department’s audit, fiscal review or provider monitoring indicates that a provider has been billing for HCBS that are inconsistent with this chapter, unnecessary or inappropriate to a participant’s needs or contrary to the participant’s ISP, the Department will suspend payment for not more than 120 days pending the Department’s review of billing and HCBS.

(c) The Department will notify a provider in writing of a suspension of payment under subsection (b).

(d) In addition to sanctions provided for in this chapter, a provider shall adhere to § § 1101.74, 1101.75, 1101.76 and 1101.77.

(e) A provider shall either replace property that was lost or damaged, or pay the participant the replacement value for the lost or damaged item if confirmed by the provider, Department or the Department’s designee through a review of the circumstances that a participant’s personal property was lost or damaged by the provider while providing an HCBS to the participant.

(f) Subsections (a)—(c) do not apply to an SSW provider.