(1) In the absence of compliance with any provider based entity requirements of ARM 37.86.3031, 37.86.3033, or 37.86.3037;

(a) the department will recover the difference between the amount of payments that were actually made to the provider based entity for both the professional and facility portions and the amount of payments that the department estimates should have been made to the professional only under ARM 37.86.105;

(b) the provider based entity may not bill as nor receive payment as a provider based entity until the department determines that the provider based entity is again in compliance with these rules;

(c) the provider may not continue to bill as a provider based entity after 30 days from the date of notice of determination of noncompliance;

(i) the department may terminate all payment to the provider, facility, or organization as of the date the department issued notice of noncompliance if the provider does not terminate billing as in (1)(c).

(2) A notice of failure of compliance with provider based entity status will be sent in writing to the provider based entity.

(a) If the department does not receive a response within 30 days after notification to the provider based entity, the department will make 100% payment deductions until full recovery is made. Recovery will be undertaken even though the provider disputes in whole or in part the department's determination of the overpayment and requests a fair hearing.

(b) The amount of any overpayment constitutes a debt due the department as of the date of initial request for payment and may be recovered from any person, party, transferee, or fiduciary who has benefited from either the payment or from a transfer of assets.

(3) Providers aggrieved by adverse determinations by the department may request an administrative review and fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.