Section 29-1306. SUSPENSION OF MEDICAID PAYMENTS FOR OVERPAYMENT-PROCEEDING

 

1306.1Whenever the Director has determined that a suspension of payments under §1305 shall be put into effect with respect to a provider, the Director shall notify the provider of his or her intention to suspend payments, in whole or in part, and the reasons for making the suspension.

 

1306.2If the reason for suspending payments is that the Director has determined that the provider has been overpaid and the suspension is needed to aid in recovery, the notice to the provider under §1306.1 shall include the following:

 

(a)The factual basis for the determination of overpayments including the dollar value of the overpayment;

 

(b)How the overpayment was computed; and

 

(c)Specific reference to the particular sections of the statutes, rules, provider's manual and/or provider's agreement involved.

 

1306.3If the reason for the intended suspension is that the Director has reliable evidence that the provider has been overpaid, the notice to the provider shall include the following:

 

(a)The reasons for making the suspension; and

 

(b)Any actions the Director intends to take to determine if any overpayment has been made.

 

1306.4Within thirty (30) days of the date in which the notice is sent to the provider under this section, the provider may submit documentary evidence and written argument against the proposed action.

 

1306.5For good cause shown, the Director may extend the thirty (30) day period.

 

1306.6If no statement is received from the provider within the thirty (30) day period or the additional thirty (30) day period specified in the notice, the suspension shall go into effect on the date after the end of the period.

 

1306.7The provisions of this section shall not apply when the Director, after furnishing a provider a written notice of the amount of the program reimbursement pursuant to §1309, suspends payment under that section.

 

source

Final Rulemaking published at 31 DCR 3870 (August 3, 1984).