WAC 110-50-0980. Third party liability claim denials

The department: (1) Must: (a) Deny third party liability claims: (i) That are not supported or substantiated by the evidence submitted; (ii) For items or amounts not covered or excluded by the terms, limitations, or exclusions of the third party liability reimbursement program; (iii) For ineligible placements; or (iv) When the property damages, personal injuries, or emergency medical expenses are misrepresented or willfully concealed by the licensed caregivers or other parties involved; and (b) Report third party liability claims found to be fraudulent involving theft or collusion involving public funds, per RCW 43.09.185 ; and (2) May: (a) Recover payments made for third party liability claims that were determined to be ineligible; or (b) Refer third party liability claims found to be fraudulent involving theft or collusion involving public funds to the assistant attorney general and local law enforcement.