If the final decision and order upholds the finding of the Director
that the fee or charge in dispute was not in accordance with prevailing
community charges or the provider's customary charges, the person
claiming such fee or cost charge shall be given thirty (30) days after
filing of such decision and order to make the necessary adjustment. If
such person still refuses to make the required readjustment, such person
shall not be authorized to conduct any further treatments or
examinations (if a physician) or to provide any other services or
supplies (if by other than a physician). Any fee or cost charge
subsequently incurred for services performed or supplies furnished shall
not be a reimbursable medical expense under this subpart. This
prohibition shall apply notwithstanding the fact that the services
performed or supplies furnished were in all other respects necessary and
appropriate within the provision of these regulations. However, the
Director may direct reimbursement of medical claims for services
rendered if such services were rendered in an emergency (see
Sec. 702.435(b)). At the termination of the proceedings provided for in
this section the district director shall determine whether further
proceedings under Sec. 702.432 should be initiated.
[50 FR 403, Jan. 3, 1985]
