Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 1.4 - Program Integrity and Appeals
Section 1.4-10 - Provider payments during pendency of applicant or member appeals; recovery
Current through March 20, 2024
Authority: IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15-13-2; IC 12-15-13-3.5; IC 12-15-13-4
Sec. 10.
(a) The office may recover payment from any provider listed in subsection (c) for services rendered to an individual if such services are determined to have been not medically necessary or not reasonable or otherwise inappropriate. Recovery of payments may be made as follows:
(b) The office may recoup under subsection (a) when the appeal has been voluntarily dismissed by the appellant.
(c) Services for which the office may recover payment under subsection (a) are limited to those rendered by any of the following providers:
(d) Interest shall be assessed on amounts recouped under this section and shall accrue from the date of the overpayment. Such interest charge shall be determined under IC 12-15-13-3.5 (g) for a noninstitutional provider or IC 12-15-13-4 (h) for an institutional provider.