Rule 23-305-1.3 - OverpaymentsA. Providers must notify the Division of Medicaid's Office of Program Integrity in writing within thirty (30) calendar days of the discovery of any overpayments. 1. Any self-disclosure of overpayments submitted to the Division of Medicaid must include the following information: a) Name and address of the affected provider, b) A provider which is entity owned, controlled, or otherwise part of a system or network must include: 1) A description or diagram of any pertinent business/legal relationships, 2) The names and addresses of any related and/or affected entities, corporate divisions, departments, or branches, and 3) The name and address of the disclosing entity's designated representative, c) Medicaid provider number(s) associated with claims, d) Tax identification number(s), e) Payee identification number(s), f) Affected claims submitted in Excel or Access which must include the following information: 2) Claim transmittal control number (TCN), g) A report that includes a full description of the information being disclosed, the person who identified the overpayment and the manner in which the individual discovered it, h) A detailed account of the provider's investigation of the overpayment, i) A statement disclosing whether the provider is under investigation by any government agency or contractor, j) A statement detailing the provider's explanation of the cause of the overpayment, k) A certification that the information submitted to the Division of Medicaid is based upon a good faith effort to disclose a billing inaccuracy and is true and correct, and l) The methodology used in determining the amount of the overpayment. 2. The provider must submit additional information to the Office of Program Integrity as requested in order to verify the information submitted including the financial impact. 3. Any issues discovered during the verification process which are outside the scope of the self-disclosure may be treated as new matters subject to further investigation. 4. Refunds to the Division of Medicaid for overpayments must be conducted through the claims payment adjustment process or in the form of a refund check within thirty (30) calendar days of the overpayment discovery. 5. Self-disclosure does not release the provider from any other cause of action, civil or criminal, by another state agency or department of the United States under applicable law and regulations regarding these payments. B. The Division of Medicaid, or designee, will send a demand letter via certified mail return receipt requesting the refund of overpayments discovered through audit or investigation: 1. On or before thirty (30) calendar days of the receipt of the demand letter, sent via certified mail, or thirty (30) calendar days from the date of the letter if the provider does not sign the certified mail notice, the provider must: a) Request an administrative hearing [Refer to Miss. Admin. Code Part 300], or b) Refund the overpayment by: 2) Offsetting against current payments through the claims payment adjustment process until overpayment is recovered, 3) A repayment agreement executed between the provider and the Division of Medicaid, or 4) Any other method of recovery available to and deemed appropriate by the Division of Medicaid. 2. Providers that fail to refund overpayments as described in Miss. Admin. Code Part 305, Rule 1.3.B.1.b) within the thirty (30) calendar day timeframe, may: a) Be placed under investigation for waste and/or abuse of the Medicaid program, and b) Be subject to charges for any allowable interest under state law which will begin accruing thirty-one (31) calendar days after receipt of the demand letter sent via certified mail, or thirty (30) calendar days from the date of the letter if the provider does not sign the certified mail notice. C. The Division of Medicaid will accept reimbursement for overpayments without penalty in the event that: 1. Overpayments are disclosed voluntarily and in good faith, and 2. The acts that led to the overpayments were not the result of fraudulent or abusive conduct. D. The Division of Medicaid will refund any payment recovered in error. 23 Miss. Code. R. 305-1.3
42 C.F.R. Part 455; Miss. Code Ann. § 43-13-121.