Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 24 - WYOMING HOSPITAL REIMBURSEMENT SYSTEM
Section 24-12 - Audits

(a) Field audits. The Department or HCFA may perform a field audit of a provider at any time to determine the accuracy and reasonableness of cost reports, the accuracy of cost settlements or whether the hospital has received excess payments.

(b) Desk review. The Department or HCFA may perform a desk review of a provider at any time to determine the accuracy and reasonableness of cost reports, the accuracy of cost settlements or whether the hospital has received excess payments.

(c) The Department or HCFA may perform field audits or desk reviews through employees, agents, or through a third party. Audits shall be performed in accordance with GAAS.

(d) Disallowances. If a field audit or desk review discloses nonallowable costs, overpayments or excess payments, the Department shall adjust the final cost settlement and recover any excess payments pursuant to Section 14.

(e) Notice of excess payments. After determining that a provider has received excess payments, the Department shall send written notice to the provider, by certified mail, return receipt requested, stating the amount of the excess payments, the basis for the determination of excess payments and the providers right to request reconsideration of that determination pursuant to Section 17. The reconsideration shall be limited to whether the Department has complied with the provisions of this rule.

(f) Recovery of excess payments. A provider must reimburse the Department for excess payments within fifteen days after the provider receives written notice from the Department pursuant to subsection (e), even if the provider has requested reconsideration or an administrative hearing regarding the determination of excess payments. If the provider fails to timely repay excess payments, the Department may recover the excess payments pursuant to Sections 14.