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C. History of prior violation(s); D. Prior imposition of sanction(s); E. Provider failure to obey program rules and policies as specified in the appropriate Provider Manual or other official notices. HISTORY: Amended by SCSR42–5 Doc. No. 4746, eff May 25, 2018. 126–403. Grounds for Sanction. The grounds for sanctioning providers shall include, but not be limited to, the following: A. Presenting or causing to be presented for payment any false or fraudulent claim for services or merchandise. B. Submitting or causing to be submitted false information for the purpose of obtaining greater compensation than that to which the provider is legally entitled, including charges in excess of the fee schedule or usual and customary charges. C. Submitting or causing to be submitted false information for the purpose of meeting prior authorization requirements. D. Failure to disclose or make available to the Single State Agency or its authorized agent records of services provided to Medicaid beneficiaries and records of payment made therefore. E. Continuing a course of conduct deemed abusive of the Medicaid Program after receiving written notice from the Single State Agency that said conduct must cease, provided that the written notice shall specify the practices deemed abusive. F. Breach of the terms of the Medicaid provider agreement or failure to comply with the terms of provider certification on the Medicaid claim form. G. Over-utilizing the Medicaid Program by including, furnishing, or otherwise causing a beneficia- ry to receive service(s) or merchandise not otherwise required by the beneficiary. H. Rebating or accepting a fee or portion of a fee or charge for a beneficiary referral. I. Submission of a false or fraudulent application for provider status. J. Conviction against a provider for a criminal offense related to his or her involvement in the Medicaid or Medicare Program. K. Failure to meet standards required by State or Federal law for Medicaid participation (i.e., failed to meet the licensing requirements constituting minimum qualification). L. Exclusion from Medicare because of fraudulent or abusive practices (i.e., terminated or suspend- ed from participation in the Medicare Program under 42 CFR, Part 1001.) M. Failure to correct deficiencies in provider operations after receiving written notice of these deficiencies from the Single State Agency. N. Failure to repay or make arrangements for the repayment of identified overpayments or otherwise erroneous payments. O. Termination for cause under Medicare or under the Medicaid or CHIP program of any other State [42 CFR § 455.416 and Section 6501 of the Affordable Care Act] HISTORY: Amended by SCSR42–5 Doc. No. 4746, eff May 25, 2018. 126–404. Fair Hearings. A. Any Medicaid provider who has been notified in writing by the Single State Agency of a proposed recoupment of overpayments, a proposed exclusion, suspension or termination due to an administrative determination of abuse, or a proposed exclusion, suspension or termination due to a program related conviction in a state or federal court, may exercise his right to a fair hearing pursuant to R.126–150 prior to implementation of the proposed action. This subparagraph applies only to postpayment reviews of providers which are conducted by the Department. Further, this subparagraph shall not apply in the case of a provider who has been excluded, suspended or terminated from participation in the Medicare program, in which case the provisions of 42 CFR, Part 1001, shall apply. B. Any individual Medicaid practitioner who has been convicted of a criminal offense related to his involvement in the Medicare or Medicaid Program and who is subsequently excluded, suspended or