2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 13. Provider Payment; General › 12-15-13-3.5. Recovery of Overpayment to Noninstitutional Provider; Appeal

Sec. 3.5. (a) As used in this section, "noninstitutional provider" means any Medicaid provider other than the following:
(1) A health facility licensed under IC 16-28.
(2) An ICF/IID (as defined in IC 16-29-4-2).
(b) If the office of the secretary or the office of the secretary's designee believes that an overpayment to a noninstitutional provider has occurred, the office of the secretary or the office of the secretary's designee may submit to the noninstitutional provider a preliminary review of draft audit findings.
(c) A noninstitutional provider that receives a preliminary review of draft audit findings under subsection (b) may request administrative reconsideration of the preliminary review of draft audit findings not later than forty-five (45) days after the issuance of the preliminary review of draft audit findings. The noninstitutional provider may submit comments along with the request for administrative reconsideration. The noninstitutional provider must request administrative reconsideration before filing an appeal.
(d) Following administrative reconsideration of the preliminary review of draft audit findings and any comments submitted along with the noninstitutional provider's request for administrative consideration and if the office of the secretary or the office of the secretary's designee believes that an overpayment has occurred, the office of the secretary or the office of the secretary's designee shall notify the noninstitutional provider in writing that the office of the secretary or the office of the secretary's designee:
(1) believes that the overpayment has occurred; and
(2) is issuing a final calculation of the overpayment.
(e) A noninstitutional provider who receives a notice under subsection (d) may elect to do one (1) of the following:
(1) Repay the amount of the final calculation not later than three hundred (300) days after the provider received the notice under subsection (d), including interest:
(A) due from the noninstitutional provider; and
(B) accruing from the date of overpayment.
(2) Request a hearing by filing an administrative appeal not later than sixty (60) days after receiving the notice under subsection (d) and repay the amount of the final calculation of the overpayment under subsection (d) not later than three hundred (300) days after receiving the notice under subsection (d).
(f) If:
(1) a noninstitutional provider elects to proceed under subsection (e)(2); and
(2) the office of the secretary or the office of the secretary's designee determines after the hearing and any subsequent appeal that the noninstitutional provider does not owe the money that the office of the secretary or the office of the secretary's designee believed the noninstitutional provider owed;
the office of the secretary or the office of the secretary's designee shall return the amount of the alleged overpayment, and any interest paid by the noninstitutional provider, and pay the noninstitutional provider interest on the money from the date of the noninstitutional provider's repayment.
(g) Interest that is due under this section shall be paid at a rate that is determined by the commissioner of the department of state revenue under IC 6-8.1-10-1(c) as follows:
(1) Interest due from a noninstitutional provider to the state shall be paid at the rate set by the commissioner for interest payments from the department of state revenue to a taxpayer.
(2) Interest due from the state to a noninstitutional provider shall be paid at the rate set by the commissioner for interest payments from the department of state revenue to a taxpayer.
(h) Interest on an overpayment to a noninstitutional provider is not due from the noninstitutional provider if the overpayment is the result of an error of:
(1) the office; or
(2) a contractor of the office;
as determined by the office of the secretary or the office of the secretary's designee.
(i) If interest on an overpayment to a noninstitutional provider is due from the noninstitutional provider, the secretary or the secretary's designee may, in the course of negotiations with the noninstitutional provider regarding an appeal filed under subsection (e), reduce the amount of interest due from the noninstitutional provider.
(j) Proceedings under this section are subject to IC 4-21.5.
As added by P.L.229-2011, SEC.125. Amended by P.L.35-2016, SEC.39.