Casualty Cases

Casualty Cases A. In the event a provider has knowledge that an individual is a Medicaid beneficiary and is receiving or has received health care services which may be covered by Medicaid as a result of the accident or incident, the provider is prohibited from: 1. Demanding any payment from the Medicaid beneficiary or his representative, or 2. Pursuing collection of any type against the Medicaid beneficiary or his representative. B. A provider who has filed and accepted Medicaid payment and who fails to notify the Division of Medicaid that the provider has also received payment from a third party will be referred to the Medicaid Fraud Control Unit for investigation/prosecution for any possible violation of federal or state laws. C. A provider may be excluded from participation in the Medicaid Program if the provider: 1. Accepts payment from a third party and fails to comply with the provisions of this policy, or 2. Fails to refund to Medicaid a duplicate payment within thirty (30) days of receipt of the duplicate payment.