Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1101 - GENERAL PROVISIONS › FEES AND PAYMENTS › Section 1101.69a - Establishment of a uniform period for the recoupment of overpayments from providers (COBRA)

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For
				  overpayments relating to cost reporting periods ending prior to October 1,
				  1985, which were not appealed prior to February 6, 1988, the Department will
				  use its current policy specified in §§
										1101.84(b)(4) and
				  (5) and
				  1181.101(f)
				  (relating to provider right of appeal; and facility's right to a
				  hearing).
(b) For overpayments
				  relating to cost reporting periods ending on or after October 1, 1985, the
				  Department will use the following recoupment procedure:
(1) If an analysis of the provider's audit
				  report and the Department's payment records, by the Office of the Comptroller,
				  discloses that an overpayment has been made, or if the provider notifies the
				  Department in writing that an overpayment has occurred, the Office of the
				  Comptroller will issue a letter to the provider notifying the provider of the
				  amount of the overpayment. The letter will request that the provider contact
				  the Office of the Comptroller within 15 days of the date of the letter to
				  establish a repayment schedule. The provider's invoices (MA 309C) will continue
				  to be processed by the Department. The date of the cost settlement letter will
				  serve as day one in determining relevant time frames.
(2) If the provider does not submit an
				  acceptable repayment plan to the Department or fails to respond to the cost
				  settlement letter within the specified time period, the Department will offset
				  the overpayment amount against the provider's pending MA payments until the
				  overpayment is satisfied.
(3) An
				  acceptable repayment schedule includes either direct payment to the Department
				  by check from the provider or a request by the provider to have the overpayment
				  offset against the provider's pending claims until the overpayment is
				  satisfied. To be acceptable, a direct repayment plan or an intermittent offset
				  plan must ensure the total overpayment amount will be repaid to the Department
				  no later than the date the Department must credit the Federal government with
				  the Federal share of the overpayment. Under current Federal procedure, the
				  overpayment would be due at the end of the calendar quarter during which the
				  60th day from the date of the cost settlement letter falls.
(4) The Department reserves the right to
				  refuse to allow a direct repayment plan if a provider chose this method, but
				  failed to remit payment as agreed for a previous overpayment. When the provider
				  fails to remit payment, the Department will offset the overpayment against the
				  provider's MA payments until the overpayment is satisfied.
(5) The procedures in this subsection do not
				  apply if the provider is bankrupt or out-of-business under section
				  1903(d)(2)(D) of the Social Security Act (42 U.S.C.A. §
												1396b(d)(2)(D)).
(6) An appeal by the provider of the
				  Department's action to offset the overpayment against the provider's MA
				  payments when the provider fails either to respond timely to the cost
				  settlement letter or to pay the overpayment directly when due will not stay the
				  Department's action.
(7) An appeal
				  by the provider of the audit disallowance does not suspend the provider's
				  obligation to repay the amount of the overpayment to the Department. If the
				  provider prevails in whole or in part in the appeal and is thereby owned money
				  by the Department, the Department will refund money due the provider as a
				  result of the provider's appeal.