HAR §17-1741-3
HAR §17-1741-3. Surveillance and utilization review
Cite as Haw. Code R. § 17-1741-3
To safeguard against unnecessary or inappropriate use
of services under the medical assistance program,
excess payments and to assess the quality of those
services, the department shall:
UNOFFICIAL
1741-2
(1) Conduct post payment reviews and audits of a
statistically significant sampling of
provider claims;
(2) Compare provider and recipient utilization of
services to establish statistical models of
average provider and recipient utilization
patterns;
(3) Select for review those providers and
recipients with exceptional utilization
patterns; and
(4) Take necessary remedial measures and
corrective action to ensure the effectiveness
of the program. [Eff 08/01/94 ] (Auth:
HRS §346-14; 42 C.F.R. §§430.10, 431.10,
456.1) (Imp: 42 C.F.R. §§456.1,
456.3-456.6, 456.22, 456.23)