This text of Indiana § 12-15-13-3.5 (Recovery of overpayment to noninstitutional provider; appeal) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
5.
(a)As used in this section,
"noninstitutional provider" means any Medicaid provider other than the
following:
(1)A health facility licensed under IC 16-28.
(2)An ICF/IID (as defined in IC 16-29-4-2).
(b)If the office of the secretary or the office of the secretary's
designee believes that an overpayment to a noninstitutional provider
has occurred, the office of the secretary or the office of the secretary's
designee may submit to the noninstitutional provider a preliminary
review of draft audit findings.
(c)A noninstitutional provider that receives a preliminary review of
draft audit findings under subsection (b) may request administrative
reconsideration of the preliminary review of draft audit findings not
later than forty-five (45) days after the issuance of the preliminary
revi
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5. (a) As used in this section,
"noninstitutional provider" means any Medicaid provider other than the
following:
(1) A health facility licensed under IC 16-28.
(2) An ICF/IID (as defined in IC 16-29-4-2).
(b) If the office of the secretary or the office of the secretary's
designee believes that an overpayment to a noninstitutional provider
has occurred, the office of the secretary or the office of the secretary's
designee may submit to the noninstitutional provider a preliminary
review of draft audit findings.
(c) A noninstitutional provider that receives a preliminary review of
draft audit findings under subsection (b) may request administrative
reconsideration of the preliminary review of draft audit findings not
later than forty-five (45) days after the issuance of the preliminary
review of draft audit findings. The noninstitutional provider may
submit comments along with the request for administrative
reconsideration. The noninstitutional provider must request
administrative reconsideration before filing an appeal.
(d) Following administrative reconsideration of the preliminary
review of draft audit findings and any comments submitted along with
the noninstitutional provider's request for administrative consideration
and if the office of the secretary or the office of the secretary's designee
believes that an overpayment has occurred, the office of the secretary
or the office of the secretary's designee shall notify the noninstitutional
provider in writing that the office of the secretary or the office of the
secretary's designee:
(1) believes that the overpayment has occurred; and
(2) is issuing a final calculation of the overpayment.
(e) A noninstitutional provider who receives a notice under
subsection (d) may elect to do one (1) of the following:
(1) Repay the amount of the final calculation not later than three
hundred (300) days after the provider received the notice under
subsection (d), including interest:
(A) due from the noninstitutional provider; and
(B) accruing from the date of overpayment.
(2) Request a hearing by filing an administrative appeal not later
than sixty (60) days after receiving the notice under subsection (d)
and repay the amount of the final calculation of the overpayment
under subsection (d) not later than three hundred (300) days after
receiving the notice under subsection (d).
(f) If:
(1) a noninstitutional provider elects to proceed under subsection
(e)(2); and
(2) the office of the secretary or the office of the secretary's
designee determines after the hearing and any subsequent appeal
that the noninstitutional provider does not owe the money that the
office of the secretary or the office of the secretary's designee
believed the noninstitutional provider owed;
the office of the secretary or the office of the secretary's designee shall
return the amount of the alleged overpayment, and any interest paid by
the noninstitutional provider, and pay the noninstitutional provider
interest on the money from the date of the noninstitutional provider's
repayment.
(g) Interest that is due under this section shall be paid at a rate that
is determined by the commissioner of the department of state revenue
under IC 6-8.1-10-1(c) as follows:
(1) Interest due from a noninstitutional provider to the state shall
be paid at the rate set by the commissioner for interest payments
from the department of state revenue to a taxpayer.
(2) Interest due from the state to a noninstitutional provider shall
be paid at the rate set by the commissioner for interest payments
from the department of state revenue to a taxpayer.
(h) Interest on an overpayment to a noninstitutional provider is not
due from the noninstitutional provider if the overpayment is the result
of an error of:
(1) the office; or
(2) a contractor of the office;
as determined by the office of the secretary or the office of the
secretary's designee.
(i) If interest on an overpayment to a noninstitutional provider is due
from the noninstitutional provider, the secretary or the secretary's
designee may, in the course of negotiations with the noninstitutional
provider regarding an appeal filed under subsection (e), reduce the
amount of interest due from the noninstitutional provider.
(j) Proceedings under this section are subject to IC 4-21.5.