WAC 110-50-1080. Caregiver reimbursement program claim denials

The department: (1) Will: (a) Deny caregiver reimbursement program 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 caregiver reimbursement program; (iii) For ineligible placements; or (iv) When the property damages, property loss, or emergency medical expenses are misrepresented or willfully concealed by caregivers or other parties involved; and (b) Report caregiver reimbursement program claims found to be fraudulent or involving theft or collusion involving public funds per RCW 43.09.185 ; and (2) May: (a) Recover payments made for caregiver reimbursement program claims that were determined to be ineligible; or (b) Refer caregiver reimbursement program claims found to be fraudulent involving theft or collusion involving public funds to the assistant attorney general and local law enforcement.