Or. Admin. Code § 333-004-3180

Current through Register Vol. 63, No. 11, November 1, 2024

Section 333-004-3180 - Recovery of RH Access Fund Overpayments to Agencies Resulting from Review or Audit

(1) When the RH Program determines that an overpayment has been made to an agency, the amount of overpayment is subject to recovery.

(a) If the RH Program determines by the random sampling method set forth in OAR 333-004-3160(2) (Review or Audit of RH Access Fund Claims) that there has been an overpayment, an agency may request a 100 percent audit of all billings submitted to the RH Program for reproductive health or abortion services provided during the period in question.

(b) If an agency requests a 100 percent audit:

(A) The agency is responsible for payment and arrangement; and

(B) The audit must be conducted by a certified public accountant who is knowledgeable with the Oregon Administrative Rules covering the payments in question and must be conducted within 120 calendar days of the request to use such audit in lieu of the RH Program's random sample.

(2) The amount of the review or audit overpayment to be recovered:

(a) Is the entire amount determined by the RH Program or the amount agreed to by the RH Program and the agency;

(b) Is not limited to amounts determined by criminal or civil proceedings; and

(c) Includes interest charged at allowable state rates.

(3) The RH Program shall deliver to an agency by registered or certified mail or in person a request for repayment of the overpayment and the documentation to support the overpayment amount.

(4) The overpayment is due and payable 30 calendar days from the date of the decision by the RH Program:

(a) An agency may request an additional 30 calendar day grace period from the RH Program.

(b) A request for a hearing does not change the date the repayment of the overpayment is due.

(5) The RH Program may extend the reimbursement period for an agency or accept an offer of repayment terms from an agency. Any change in reimbursement period or terms must be made in writing by the RH Program.

(6) If the agency refuses to reimburse the overpayment or does not adhere to an agreed upon payment schedule, the RH Program may:

(a) Recoup future agency payments up to the amount of the overpayment;

(b) Suspend or terminate the agency's certification; or

(c) Pursue civil action to recover the overpayment.

(7) The RH Program may, at any time, change the amount of the overpayment upon receipt of additional information. The RH Program shall notify an agency in writing of any changes. Any monies paid to the RH Program by an agency that exceed an overpayment shall be refunded to the agency.

(8) If an agency is terminated or sanctioned for any reason, the RH Program may pursue civil action to recover any amounts due and payable to the RH Program.

Or. Admin. Code § 333-004-3180

PH 84-2020, adopt filed 12/18/2020, effective 1/1/2021; PH 193-2022, minor correction filed 09/07/2022, effective 9/7/2022

Statutory/Other Authority: ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149 & OL 2022, ch. 45, sec. 10

Statutes/Other Implemented: ORS 414.432, ORS 431.147, ORS 413.032 & OL 2022, ch. 45, sec. 10