Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 80 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATE; OTHER TYPES OF CARE › Section 12VAC30-80-130 - Refund of overpayments

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Providers reimbursed on the basis of a fee plus cost of materials.
1. When DMAS determines an overpayment has
				been made to a provider, DMAS shall promptly send the first demand letter
				requesting a lump sum refund. Recovery shall be undertaken even though the
				provider disputes in whole or in part DMAS's determination of the
				overpayment.
2. If the provider
				cannot refund the total amount of the overpayment within 30 days after
				receiving the DMAS demand letter, the provider shall promptly request an
				extended repayment schedule.
3.
				DMAS may establish a repayment schedule of up to 12 months to recover all or
				part of an overpayment or, if a provider demonstrates that repayment within a
				12-month period would create severe financial hardship, the Director of the
				Department of Medical Assistance Services (the "director") may approve a
				repayment schedule of up to 36 months.
4. A provider shall have no more than one
				extended repayment schedule in place at one time. If an audit later uncovers an
				additional overpayment, the full amount shall be repaid within 30 days unless
				the provider submits further documentation supporting a modification to the
				existing extended repayment schedule to include the additional
				amount.
5. If, during the time an
				extended repayment schedule is in effect, the provider withdraws from the
				Program, the outstanding balance shall become immediately due and
				payable.
6. When a repayment
				schedule is used to recover only part of an overpayment, the remaining amount
				shall be recovered by the reduction of interim payments to the provider or by
				lump sum payments.
7. In the
				request for an extended repayment schedule, the provider shall document the
				need for an extended (beyond 30 days) repayment and submit a written proposal
				scheduling the dates and amounts of repayments. If DMAS approves the schedule,
				DMAS shall send the provider written notification of the approved repayment
				schedule, which shall be effective retroactive to the date the provider
				submitted the proposal.
8. Once an
				initial determination of overpayment has been made, DMAS shall undertake full
				recovery of such overpayment whether the provider disputed, in whole or in
				part, the initial determination of overpayment. If an appeal follows, interest
				shall be waived during the period of administrative appeal of an initial
				determination of overpayment.
9.
				Interest charges on the unpaid balance of any overpayment shall accrue pursuant
				to § 32.1-313 of the Code of Virginia from the date the director's
				determination becomes final.
10.
				The director's determination shall be deemed to be final on (i) the issue date
				of any notice of overpayment, issued by DMAS, if the provider does not file an
				appeal, or (ii) the issue date of any administrative decision, issued by DMAS
				after an informal fact finding conference, if the provider does not file an
				appeal, or (iii) the issue date of any administrative decision signed by the
				director, regardless of whether a judicial appeal follows. In any event,
				interest shall be waived if the overpayment is completely liquidated within 30
				days of the date of the final determination. In cases in which a determination
				of overpayment has been judicially reversed, the provider shall be reimbursed
				that portion of the payment to which it is entitled, plus any applicable
				interest which the provider paid to DMAS.