• Loss of reputation among peers due to unethical clinical practice or attitude
• The practice of fraud, waste and/or abuse
• Adverse publicity involving the provider due to acts of omission or commission
• Substance abuse
• Loss of professional office
• Inadequate record keeping
• Unsafe environment in the provider’s office relative to inadequate access or other related issues that might cause a member injury
• An office that is improperly kept, unclean or does not present a proper appearance
• Failure to meet OSHA guidelines
• Failure to meet ADA guidelines
• Failure to maintain state license or DEA
• Failure to maintain Malpractice Insurance according to state minimum
• Failure to meet Clinical Laboratory Improvement Amendments (CLIA) guidelines
• Repetitive complaints about office staff demeanor, presentation and appearance
• Inclusion on the Debarred Providers Listing of the Office of the Inspector General of the Department of Health and Human Services (see Sanctioned Providers), Sams List or Preclusion List
• Unfavorable inpatient- or outpatient-related indicators:
• Severity-adjusted morbidity and mortality rates above established norms
• Severity-adjusted length-of-stay above established norms
• Unfavorable outpatient utilization results
• Consistent inappropriate referrals to specialists
• Improper maintenance of high-risk patients, such as those members with diabetes and hypertension
• Underutilization relative to minimum standards of care established per medical management guidelines and/or accepted clinical practice in the community
• Unfavorable malpractice-related issues
• Frequent litigious activity above and beyond what would be expected for a provider in that particular specialty

IntegraNet providers have 30 calendar days to appeal a termination. The IntegraNet process is designed to comply with all state and federal regulations regarding the termination appeal process.