Ch. 16, § 15. Recovery of Overpayments from Providers or Clients

(a) The Department shall recover overpayments from providers. The Department may recover overpayments from a clinic, group, corporation, professional association, or other organization of any current or former member of that practice. The Department may also recover overpayments from an individual provider that was formerly part of a clinic, group, corporation, professional association or other organization. The Department shall recover overpayments from a client that has engaged in abuse of services, fraud, or waste resulting in an overpayment. (b) After determining that a provider or client has received overpayments, the Department shall send written notice, via certified mail, return receipt requested, to the provider or client. In addition to any additional notice requirements, the notice shall include: (i) The amount of the overpayments; and (ii) The basis for the determination of overpayments. (c) A provider or client shall reimburse the Department for overpayments within thirty (30) business days after the provider or client receives written notice from the Department of the overpayments. Neither the filing of a request for reconsideration nor a request for an administrative hearing shall stay the effective date of the adverse action. (d) If a provider or client does not timely reimburse the Department, following final administrative action, the Department shall recover the overpayments by: (i) Withholding all or part of future Medicaid payments: (A) Payments shall be withheld at one hundred percent (100%); (B) Payment arrangements may be entered into if the provider or client can demonstrate that one hundred percent (100%) withholding will result in an undue hardship, with the approval of the State Medicaid Agent or the Agent's designee; (ii) Initiating a civil lawsuit against the provider or client; or (iii) Any other method of collecting a debt or obligation permitted by law. (e) If the provider is bankrupt or out of business, the Department shall notify the provider that an overpayment exists and take reasonable action to recover the overpayment during the three hundred and sixty-five (365) day recovery period in accordance with 42 CFR § 433.318. The Department shall take action to be listed as a creditor in the bankrupt proceedings.