§ 14171.6. — 14171.6. (Amended by Stats. 2016, Ch. 31, Sec. 284.)

California § 14171.6.

• Jurisdiction: California
• Code WIC: Welfare and Institutions Code - WIC
• Div. 9.: DIVISION 9. PUBLIC SOCIAL SERVICES
• Part 3.: PART 3. AID AND MEDICAL ASSISTANCE
• Ch. 7.: CHAPTER 7. Basic Health Care
• Art. 5.3.: ARTICLE 5.3. Audit, Appeal, and Recovery of Overpayments

Text

(a)
(1)
Any provider, as defined in paragraph (3), that obtains reimbursement under this chapter to which it is not entitled shall be subject to interest charges or penalties as specified in this section.
(2)
When it is established upon audit that the provider has not received reimbursement to which the provider is entitled, the department shall pay the provider interest assessed at the rate, and in the manner, specified in subdivision (g) of Section 14171.
(3)
For purposes of this section, “provider” means any provider, as defined in Section 14043.1.
(b)
When it is established upon audit that the provider has claimed payments under this chapter to which it is not entitled, the provider shall pay, in addition to the amount improperly received, interest at the rate specified by subdivision (h) of Section 14171.
(c)
(1)
When it is established upon audit that the provider claimed payments related to services or costs that the department had previously notified the provider in an audit report that the costs or services were not reimbursable, the provider shall pay, in addition to the amount improperly claimed, a penalty of 10 percent of the amount improperly claimed after receipt of the notice, plus the cost of the audit.
(2)
In addition to the penalty and costs specified by paragraph (1), interest shall be assessed at the rate specified in subdivision
(h) of Section 14171.
(3)
Providers that wish to preserve appeal rights or to challenge the department’s positions regarding appeal issues may claim the costs or services and not be reimbursed therefor if they are identified and presented separately on the cost report.
(d)
(1)
When it is established that the provider fraudulently claimed and received payments under this chapter, the provider shall pay, in addition to that portion of the claim that was improperly claimed, a penalty of 300 percent of the amount improperly claimed, plus the cost of the audit.
(2)
In addition to the penalty and costs specified by paragraph (1), interest shall be assessed at the rate specified by subdivision (h) of Section 14171.
(3)
For purposes of
this subdivision, a fraudulent claim is a claim upon which the provider has been convicted of fraud upon the Medi-Cal program.
(e)
Nothing in this section shall prevent the imposition of any other civil or criminal penalties to which the provider may be liable.
(f)
Any appeal to any action taken pursuant to subdivision (b), (c), or (d) is subject to the administrative appeals process provided by Section 14171.
(g)
As used in this section, “cost of the audit” includes actual hourly wages, travel, and incidental expenses at rates allowable by rules adopted by the Department of General Services and applicable overhead costs that are incurred by employees of the state in administering this chapter with respect to the performance of audits.
(h)
This section
shall not apply to any clinic licensed pursuant to subdivision (a) of Section 1204 of the Health and Safety Code, clinics exempt from licensure under Section 1206 of the Health and Safety Code, health facilities licensed under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, or to any provider that is operated by a city, county, or school district.

Legislative History

Amended by Stats. 2016, Ch. 31, Sec. 284. (SB 836) Effective June 27, 2016.