MA-3535 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES

MA-3535 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES

I. PURPOSE

II. LEGAL RESPONSIBILITY AND REFERENCES

III. NORTH CAROLINA GENERAL STATUTES

IV. FRAUD VS. MISREPRESENTATION

V. PREVENTION

VI. DETECTION

VII. INVESTIGATIONS

VIII. CALCULATING OVERPAYMENTS

IX. NORTH CAROLINA HEALTH CHOICE OVERPAYMENTS

X. CONCLUSIONS AND RECOMMENDATIONS

XI. NOTICES & APPEALS

XII. ADMINISTRATIVE COLLECTION PROCEDURES

XIII. BANKRUPTCY

XIV. DISTRIBUTION OF CASH REPAYMENT

XV. EPICS REPORTING REQUIREMENTS

XVI. NC DEBT SETOFF (TAX INTERCEPT) CRITERIA FOR MEDICAID CLAIMS

XVII. NORTH CAROLINA EDUCATIONAL LOTTERY INTERCEPTIONS

XVIII. NORTH CAROLINA TITLE XIX MEDICAID/NCHC RECIPIENT PROFILES

XIX. CITATIONS AND REFERENCES