WAC 182-520-0005. Washington apple health fraud referrals and overpayments

(1) The agency or the agency's designee may refer a case to the office of fraud and accountability for a fraud investigation when it has reliable information that the person purposely misrepresented their circumstances in order to qualify for Washington apple health. (2) When a fraud investigation reveals substantial evidence to support a finding of fraud, the case is referred for prosecution. The prosecuting attorney's office decides which cases will be prosecuted. (3) When a referral results in a conviction, an overpayment amount for the cost of the apple health coverage is established. (4) The person is responsible to pay the agency for the amount of overpayment established as a result of a fraud conviction.