(1) As provided in this rule, the department must notify a provider of any adverse action it will take on a determination that the provider has engaged in fraud or abuse or has received payment to which the provider is not entitled. The notification must include:

(a) a description of the fraud, abuse or overpayments;

(b) the dollar value of any overpayment; and

(c) the adverse action to be taken or sanction to be imposed by the department;

(d) explanation of any actions required of the provider;

(e) the provider's right to a fair hearing.

(2) The department is not required to notify a provider pursuant to (1) until after the department has determined that fraud, abuse or an overpayment has occurred, the dollar amount of any overpayment and that a particular adverse action will be taken by the department against the provider, such as recovery of an overpayment or imposition of a sanction. The department is not required to notify the provider when the department merely suspects or has information which suggests that fraud, abuse or an overpayment has occurred or when the department has not determined to take a particular adverse action in response to the fraud, abuse or overpayment.

(3) Subject to the provisions of (4), the department must notify the provider as required in this rule within 45 days after the department has determined that fraud, abuse or an overpayment has occurred, the dollar amount of any overpayment and the adverse action that will be taken against the provider. The department's failure to notify a provider as required by this rule is not a defense to recovery of the overpayment or imposition of the sanction, but the department may be required to provide a new notice in compliance with this rule.

(4) This rule shall not be construed to require that the department investigate, complete an investigation, make a determination or take any other action regarding a potential fraud, abuse or overpayment within any particular time.

(5) While this rule does not require the department to act within any particular time, if any governmental agency or entity is conducting an investigation of a provider, the department shall not in any event be required to notify the provider of a violation or overpayment until the investigation is concluded and enforcement proceedings, if any, have been completed, if in the sole discretion of the department or the governmental agency or entity conducting the investigation, earlier notification would interfere with or jeopardize the investigation, recovery of an overpayment or imposition of a sanction.