Sanction or Suspension

Priority Health will pay sanctioned providers only for emergent services.

The Office of the Inspector General (OIG) at the US Department of Health & Human Services maintains a sanction list that identifies individuals found guilty of fraudulent billing, misrepresentation of credentials, and other infractions. Priority Health checks the sanction list each time it is issued.

The Priority Health Chief Executive Officer is responsible for initiating any corrective action/sanction process in which the infraction or conduct could adversely affect the health or welfare of members. The recommendation is forwarded to the Priority Health Credentialing Committee, made up of physicians within the Priority Health network and Priority Health staff.

The sanctioned provider has an opportunity to appeal. All providers have received, in the initial credentialing packet, a Priority Health policy and procedure regarding the appeal process. For a copy of the appeal process, refer to your credentialing packet or contact your field service representative.