4. The department may terminate a qualified service provider if:

75-02-05-07. 4. The department may terminate a qualified service provider if: a. The qualified service provider voluntarily withdraws from participation as a qualified service provider. b. The qualified service provider is not in compliance with applicable state laws, state regulations, or program issuances governing providers. c. The qualified service provider is not in compliance with the terms set forth in the application or provider agreement. d. The qualified service provider is not in compliance with the provider certification terms on the claims submitted for payment. e. The qualified service provider has assigned or otherwise transferred the right to payment of a program claim, except as provided in 42 U.S.C. 1396a(a)(32). f. The qualified service provider has demonstrated a pattern of submitting inaccurate billings or cost reports. g. The qualified service provider has demonstrated a pattern of submitting billings for services not covered under department programs. h. The qualified service provider has been debarred or the provider's license or certificate to practice in the provider's profession or to conduct business has been suspended or terminated. i. The qualified service provider has delivered goods, supplies, or services that are of an inferior quality or are harmful to individuals. j. The qualified service provider has been convicted of an offense determined by the department to have a direct bearing upon the provider's ability to be enrolled as a qualified service provider, or the department determines, following conviction of any other offense, the provider is not sufficiently rehabilitated. k. The qualified service provider is currently excluded from participation in Medicare, Medicaid, or any other federal health care program. 18 l. The qualified service provider has not provided sufficient evidence to the department, after obtaining a formal evaluation under subsection 3 of section 75-03-23-07 that the provider is physically, cognitively, socially, or emotionally capable of providing the care. m. The qualified service provider refuses to repay or make arrangements for the repayment of identified overpayments or otherwise erroneous payments. n. There has been no billing activity within the twelve months since the qualified service provider's enrollment or most recent re-enrollment date. o. The qualified service provider has demonstrated a pattern of absenteeism by failing to provide care they have been authorized and agreed to provide per subsection 11 of section 75-03-23-07 to an eligible individual. p. For other good cause. History: Effective January 1, 2020; amended effective January 1, 2022; October 1, 2022; January 1, 2024. General Authority: NDCC 50-06.2-03(6) Law Implemented: NDCC 50-06.2-03(5)