Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 160 - Medicaid Program; General Provisions
Article 1 - Program Integrity and Quality Assurance
7 AAC 160.110 - Fiscal audit

(a) The department or its designee shall conduct fiscal audits of Medicaid providers their subcontractors, and their grantees. A provider that bills the department is responsible for ensuring that records related to the services bined are kept by employees, subcontractors, and grantees, are maintained in accordance with7 AAC 105.230, and are made available when requested by the department.

(b) For purposes of this section, a fiscal audit may include a desk audit, a field audit, or both, to determine the provider's compliance with the requirements of 42 U.S.C. 1396, AS 47.05, AS 47.07, 42 C.F.R. Part 430 - 42 C.F.R. Part 498, and 7 AAC 105 - 7 AAC 160.

(c) For purposes of conducting an audit under this section, the provider must allow the department or its designee, the federal government, or the Department of Law access to original financial, clinical, and other records documenting care provided to Medicaid recipients.

(d) Except as provided in (e) of this section, the department or its designee will give a provider 30 days' advance notice of an audit to be conducted under this section. The notice will

(e) The department or its designee may request and receive immediate access to records and perform an audit of those records without advance notice if the department or its designee has reason to believe, based on credible evidence, that the provider is engaging in a course of conduct or performing an act in violation of the requirements specified in (b) of this section. Notwithstanding the provisions of 7 AAC 105.240, the provider shall produce the requested records for an immediate audit under this subsection at the provider's place of business or other location as specified by the department or its designee. To provide immediate access to records under this subsection, the provider must make the records available not later than 24 hours after the request. If the provider is unable to produce the records in that timeframe, the provider shall notify the department, not later than 24 hours after the request, of the reason for the delay together with the estimated timeframe to comply.

(f) Following the department's or its designee's audit of a provider's records, the department or its designee will give the provider the written preliminary findings of the audit. The preliminary findings will identify claim-line inaccuracies. The provider has 30 days after the date of the letter informing the provider of the preliminary findings to submit additional documentation or respond to the preliminary findings.

(g) The department will issue the final audit report to the provider no more than 60 days after it has considered any documentation or response submitted under (f) of this section and the audit is complete. The final audit report will include audit or review findings and overpayment amounts identified as a result of the audit.

(h) If the department finds in the final audit report under (g) of this section that the provider has not complied with the requirements specified in (b) of this section,

(i) For purposes of this section,