ADMINISTRATIVE SANCTIONS
§ 1221.81. Provider misutilization.
Providers determined to have billed for services inconsistent with MA Program regulations, to have provided services outside the scope of customary standards of medical practice, or to have otherwise violated the standards set forth in the provider agreement, are subject to the sanctions described in Chapter 1101 (relating to general provisions).
Source The provisions of this § 1221.81 adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4599.
APPENDIX A
MEDICAL EMERGENCY
CARE SYMPTOMS
Allergy Reactions, Acute (Except Allergy Tests) Glaucoma, Severe Headache, Severe Appendicitis, Acute Heart Attack, Suspected Asthma, Acute Hemorrhage Breathing Difficulties or Shortness of Breath Hysteria Insulin Shock (Overdose) Bronchitis, Severe Kidney Stones Bursitis, Severe Onset Maternity Complications, such Chest Pain, Severe as Suspected Miscarriage Choking Pain, Sudden or Severe Onset Colitis Pleurisy Coma Pneumonitis Convulsions and/or Seizures Poisoning (including overdose) Cystitis Pyelitis Dermatitis or Hives (Resulting from Internal or Unknown Causes) Pyelonephritis (Shock) Spasms, Cerebral or Cardiac Spontaneous Pneumothorax Diabetic Coma Stomach Pains, Severe Diarrhea, Severe Strangulated Hernia Drug Reaction Stroke Earache, Severe Sunstroke Epistaxis (nosebleed) Swollen Ring Finger Fainting Tachycardia Fecal Impaction, Severe Thrombosis and/or Phlebitis Food Poisoning Unconsciousness Frost Bite Urinary Retention, Acute Gall Bladder, Acute Attack Vision loss, Sudden Onset Gastritis Vomiting, Severe Gastro-intestinal Conditions Acute
Source The provisions of this Appendix A adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4599; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial page (79331).
APPENDIX B. [Reserved]
Source The provisions of this Appendix B adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4599; amended August 7, 1981, effective August 8, 1981, 11 Pa.B. 2770; reserved December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (79331) to (79332).
APPENDIX C. [Reserved]
Source The provisions of this Appendix C adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4599; reserved December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (79332) and (60960).
APPENDIX D. [Reserved]
Source The provisions of this Appendix D adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4599; amended February 13, 1981, effective February 15, 1981, 11 Pa.B. 657; reserved December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (60960) to (60965).
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