 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 29. PUBLIC WELFARE |
|
Chapter 29-13. MEDICAID PROGRAM ADMINISTRATIVE PROCEDURES |
Section 29-1307. SUSPENSION OF MEDICAID PAYMENTS FOR OVERPAYMENT-EVIDENCE AND NOTICE
-
1307.1When the provider, pursuant to §1306, submits a statement, the Director shall consider the statement including any pertinent evidence submitted together with any other material bearing upon the case and shall make a determination as to whether the facts justify a suspension.
1307.2If the Director determines that a suspension shall go into effect, a written notice of the detemination shall be sent to the provider.
1307.3The notice shall contain specific findings on the conditions upon which the suspension was based and an explanatory statement for the final decision.
1307.4The suspension shall not take effect for at least fifteen (15) days following the date of the notice.
1307.5If the provider requests a hearing by filing a notice of appeal from the determination of suspension and overpayment with the D.C. Board of Appeals and Review within the fifteen (15) day period, the suspension shall not take effect until after a final decision is rendered following a hearing under these rules.
1307.6A request for a hearing to appeal the Director's decision to suspend shall not stay the effectiveness of the suspension, if the Director determines that there is reasonable cause to believe that the provider will not refund overpayments other than through offset of program payments by suspension.
1307.7The Director's implemention of a suspension, in whole or in part, does not in any way abrogate the right of the provider to file an appeal with the D.C. Board of Appeals and Review and to have a final decision rendered before final liability is established.
1307.8The provider has fifteen (15) days from the date of the notice sent, pursuant to §1307.4, to request a hearing by filing a notice of appeal.