Alaska Administrative Code
Title 7 - Health and Social Services
Part 7 - Medicaid Assistance Eligibility
Chapter 100 - Medicaid Eligibility
Article 14 - Recipient Rights and Responsibilities, and Program Integrity
7 AAC 100.912 - Intentional program violations, program abuse, and criminal offenses

Universal Citation: 7 AK Admin Code 100.912

Current through August 30, 2024

(a) If the department has reason to believe that an individual has committed an intentional program violation or program abuse, the department will conduct a full investigation in accordance with 42 C.F.R. 455.15. If, after a full investigation, the department determines that an individual applying for or receiving Medicaid benefits has committed an intentional program violation or program abuse, the department may

(1) deny an application for Medicaid, subject to a hearing under 7 AAC 49;

(2) proceed with recovery of Medicaid expenditures in accordance with 7 AAC 100.910, including a hearing under 7 AAC 49; and

(3) refer the matter to the appropriate authorities for civil or criminal action in a state or federal court.

(b) If an individual applying for or receiving Medicaid benefits has been convicted of an offense under AS 11, AS 17.30.080, or AS 47.05.210, and if the department has reason to believe that the conduct giving rise to the offense was related to obtaining Medicaid benefits, the department may

(1) deny an application for Medicaid, subject to a hearing under 7 AAC 49;

(2) proceed with recovery of Medicaid expenditures in accordance with 7 AAC 100.910, including a hearing under 7 AAC 49; and

(3) exclude the individual from participation in Medicaid in accordance with AS 47.05.240.

(c) The department shall coordinate action taken under (a) or (b) of this section with any corresponding action taken under 7 AAC 45 (Alaska Temporary Assistance Program) or 7 AAC 46 (Food Stamp Program) if the facts involved arise from the same or related circumstances.

(d) The department will seek recovery under 7 AAC 100.910 from an individual if, after a hearing under 7 AAC 49, the final decision is that

(1) the individual committed an intentional program violation or program abuse; or

(2) if the individual was convicted of an offense under AS 11, AS 17.30, or AS 47.05.210, the conduct giving rise to the offense was related to the obtaining of Medicaid benefits.

(e) In this section,

(1) "intentional program violation" means an action that
(A) an individual takes for the purpose of establishing and maintaining an individual's eligibility for Medicaid benefits; and

(B) intentionally misrepresents, conceals, or withholds a material fact;

(2) "program abuse" means an action that
(A) an individual takes to misuse or overuse Medicaid benefits, including medical transportation; and

(B) results in unnecessary cost to the Medicaid program.

Authority:AS 47.05.010

AS 47.05.210

AS 47.05.240

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.