Provider Overpayment Recovery Process

392 NAC 5-005

1. The overpayment is identified.
   1. If the Resource Development Unit (RD) identifies the overpayment, the RD worker refers the case to the Issuance and Collections Center (ICC) to research.
   2. If ICC identifies the overpayment, they determine the amount and period of the overpayment within 30 days. The deadline may be extended for exceptionally difficult cases.
2. RD may or may not keep the provider agreement open while ICC is auditing the case, depending on the nature of each individual situation.
3. If ICC believes the overpayment is an intentional violation, they forward the case to the Special Investigation Unit (SIU). SIU determines if criminal prosecution is appropriate.
   1. If criminal prosecution is feasible, SIU pursues criminal prosecution.
   2. If SIU determines criminal prosecution is not feasible, they refer back to ICC.
4. If ICC determines no action from SIU is required or SIU returns the case to ICC, ICC works with RD for an ongoing Corrective Action Plan.
5. When RD receives a referral for Corrective Action, the worker makes the decision to continue overpayment recovery. In serious cases, RD may terminate the provider agreement.
6. If the provider agreement:
   1. Is continued, RD develops a retrieval plan for recovery of the overpayment with ICC within 15 days. This may include provider forfeiture of a percentage of the provider's future paychecks. RD assists with any training needs and continues with audits of future billings.
   2. Is terminated, RD refers back to ICC for collection.
7. ICC handles the correspondence with the provider to recoup funds and collect the overpayments.
8. The provider has the right to appeal the existence and amount of overpayment.