Or. Admin. Code § 333-004-4110

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

Section 333-004-4110 - Recovery of Abortion Access Plan Overpayments Resulting from Review or Audit

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

(a) If the RH Program determines by the random sampling method set forth in OAR 333-004-4090 (Review or Audit of Abortion Access Plan Claims) that there has been an overpayment, an authorized agency or authorized provider may request a 100 percent audit of all billings submitted to the RH Program for abortion services provided during the period in question.

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

(A) The authorized agency or authorized provider 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 60 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 authorized agency or authorized provider;

(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 authorized agency or authorized provider 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 authorized agency or authorized provider 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 authorized agency or authorized provider, or accept an offer of repayment terms from an authorized agency or authorized provider. Any change in reimbursement period or terms must be made in writing by the RH Program.

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

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

(b) 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 authorized agency or authorized provider in writing of any changes. Any monies paid to the RH Program by an authorized agency or authorized provider that exceed an overpayment shall be refunded to the agency.

(8) If an authorized agency or authorized provider is 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 § 333-004-4110

PH 47-2023, adopt filed 09/28/2023, effective 10/1/2023

Statutory/Other Authority: ORS 413.042 & OL 2022, Ch. 435 (HB 4034, Section 10)

Statutes/Other Implemented: ORS 413.032 & OL 2022, Ch. 435 (HB 4034, Section 10)