Section 1163.91. Provider misutilization  


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  • If the Department determines that a provider billed for services inconsistent with this part, provided incorrect information on the billing invoice regarding a patient’s diagnosis or procedures performed during the period of hospitalization or otherwise violated the standards set forth in the provider agreement, the provider is subject to the sanctions described in Chapter 1101 (relating to general provisions).

The provisions of this § 1163.91 adopted September 23, 1983, effective September 24, 1983, 13 Pa.B. 2881; amended June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185. Immediately preceding text appears at serial page (86846).