OAR 333-010-0175
Recovery of Overpayments to Providers Resulting from Review or Audit


(1)

When the Center determines that an overpayment has been made to a provider, the amount of overpayment is subject to recovery:

(a)

To determine the overpayment amount, the Center may use a statistically valid random sampling, with sufficient sample size allowing a confidence interval of 95 percent.

(b)

After the Center determines an overpayment amount by the random sampling method set forth in section (1) of this rule, the provider may request a 100 percent audit of all billings submitted to the Center for breast and cervical cancer screening and diagnostic services provided during the period in question. If a 100 percent audit is requested:

(A)

Payment and arrangement for a 100 percent audit is the responsibility of the provider requesting the audit; and

(B)

The audit must be conducted by a certified public accountant that is knowledgeable about the Oregon Administrative Rules covering the payments in question, and must be conducted within 120 calendar days of the request to use such audit in lieu of the Center’s random sample.

(2)

The amount of the review or audit overpayment to be recovered:

(a)

Will be the entire amount determined or agreed to by the Center;

(b)

Is not limited to amounts determined by criminal or civil proceedings; and

(c)

Will include interest to be charged at allowable state rates.

(3)

The Center will deliver to the provider by registered or certified mail or in person a request for repayment of the overpayment and the documentation to support the alleged amount.

(4)

If the provider disagrees with the Center’s determination or the amount of overpayment the provider may appeal the decision by requesting a contested case hearing:

(a)

A written request for hearing must be submitted to the Center by the provider within 30 calendar days of the date of the decision affecting the provider. The request must specify the areas of disagreement.

(b)

Failure to request a hearing or administrative review in a timely manner constitutes acceptance by the provider of the amount of the overpayment.

(5)

The overpayment is due and payable 30 calendar days from the date of the decision by the Center:

(a)

An additional 30 day grace period may be granted the provider upon request to the Center;

(b)

A request for a hearing does not change the date the repayment of the overpayment is due.

(6)

The Center may extend the reimbursement period or accept an offer of repayment terms. Any change in reimbursement period or terms must be made in writing by the Center.

(7)

If the provider refuses to reimburse the overpayment or does not adhere to an agreed upon payment schedule, the Center may:

(a)

Recoup future provider payments up to the amount of the overpayment; or

(b)

Pursue civil action to recover the overpayment.

(8)

As the result of a hearing the amount of the overpayment may be reduced in part or in full.

(9)

The Center may, at any time, change the amount of the overpayment upon receipt of additional information. Any changes will be verified in writing by the Center. Any monies paid to the Center that exceed an overpayment will be refunded to the provider.

(10)

If a provider is terminated or sanctioned for any reason, the Center may pursue civil action to recover any amounts due and payable to ScreenWise BCC.

Source: Rule 333-010-0175 — Recovery of Overpayments to Providers Resulting from Review or Audit, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-010-0175.

333‑010‑0000
Cancer Reporting Regulations: Definitions
333‑010‑0020
Cancer Reporting Regulations: Reporting Requirements for Health Care Facilities
333‑010‑0030
Cancer Reporting Regulations: Reporting Requirements for Practitioners
333‑010‑0032
Cancer Reporting Regulations: Reporting Requirements for Clinical Laboratories
333‑010‑0035
Cancer Reporting Regulations: Patient Notification Requirement
333‑010‑0040
Cancer Reporting Regulations: Quality Standards
333‑010‑0050
Cancer Reporting Regulations: Confidentiality and Access to Data
333‑010‑0055
Cancer Reporting Regulations: Research Studies
333‑010‑0060
Cancer Reporting Regulations: Special Studies
333‑010‑0070
Cancer Reporting Regulations: Advisory Committee
333‑010‑0080
Cancer Reporting Regulations: Training and Consultation
333‑010‑0090
Cancer Reporting Regulations: Fees
333‑010‑0100
ScreenWise Breast and Cervical Cancer Program: Description of the ScreenWise Breast and Cervical Cancer Program
333‑010‑0105
Definitions
333‑010‑0110
Client Eligibility
333‑010‑0115
Client Enrollment
333‑010‑0120
Covered Services
333‑010‑0125
Excluded Services
333‑010‑0130
Standards of Care for Breast and Cervical Cancer Screening and Diagnostic Services
333‑010‑0135
Provider Enrollment
333‑010‑0140
Billing
333‑010‑0145
Claims and Data Submission
333‑010‑0150
Timely Submission of Claims and Data
333‑010‑0155
Payment
333‑010‑0160
Requirements for Financial, Clinical and Other Records
333‑010‑0165
Compliance with Federal and State Statutes
333‑010‑0170
Denial or Recovery of Reimbursement Resulting from Review or Audit
333‑010‑0175
Recovery of Overpayments to Providers Resulting from Review or Audit
333‑010‑0180
Provider Sanctions
333‑010‑0185
Provider Appeals
333‑010‑0190
Provider Appeals (Level 1) — Claims Reconsideration
333‑010‑0195
Provider Appeals (Level 2) — Contested Case Hearing
333‑010‑0197
Presumptive Eligibility for BCCTP
333‑010‑0200
ScreenWise WISEWOMAN Program: Description of the WISEWOMAN Program
333‑010‑0205
Definitions
333‑010‑0210
Client Eligibility
333‑010‑0215
Client Enrollment
333‑010‑0220
Provider Enrollment
333‑010‑0225
Standards of Care for WISEWOMAN Program Screening and Services
333‑010‑0230
Submission of Information by Ancillary Providers
333‑010‑0235
Covered Services
333‑010‑0240
Excluded Services
333‑010‑0245
Claims and Billing
333‑010‑0250
Payment
333‑010‑0255
Denial or Recovery of Reimbursement Resulting from Review or Audit
333‑010‑0260
Recovery of Overpayments to Providers Resulting from Review or Audit
333‑010‑0265
Client Data Submission
333‑010‑0270
Requirements for Financial, Clinical and Other Records
333‑010‑0275
Compliance with Federal and State Statutes
333‑010‑0280
Provider Sanctions
333‑010‑0285
Provider Appeals (Level 1) — Claims Reconsideration
333‑010‑0290
Provider Appeals (Level 2) — Contested Case Hearing
333‑010‑0300
Tobacco Prevention and Education Program: Definitions
333‑010‑0310
Tobacco Prevention and Education Program: Purpose and Intent
333‑010‑0320
Tobacco Prevention and Education Program: Framework for Grant Awards
333‑010‑0330
Tobacco Prevention and Education Program: Local Coalitions and Community-Based Programs
333‑010‑0350
Tobacco Prevention and Education Program: Statewide Public Awareness and Education Programs
333‑010‑0360
Tobacco Prevention and Education Program: Statewide and Regional Projects Programs
333‑010‑0370
Tobacco Prevention and Education Program: Reporting
333‑010‑0600
Childhood Diabetes Database: Definitions
333‑010‑0610
Childhood Diabetes Database: General Authority and Purpose
333‑010‑0620
Childhood Diabetes Database: Reporting Requirements for Schools
333‑010‑0630
Childhood Diabetes Database: Reporting Requirements for Practitioners
333‑010‑0640
Childhood Diabetes Database: Confidentiality and Access to Data
333‑010‑0650
Childhood Diabetes Database: Research Studies
333‑010‑0660
Childhood Diabetes Database: Advisory Committee
333‑010‑0700
Dental Pilot Projects: Purpose
333‑010‑0710
Dental Pilot Projects: Definitions
333‑010‑0720
Dental Pilot Projects: Application Procedure
333‑010‑0730
Dental Pilot Projects: Application Review Process
333‑010‑0740
Dental Pilot Projects: Project Application Provisional Approval or Denial
333‑010‑0750
Dental Pilot Projects: Provisional Approval
333‑010‑0760
Dental Pilot Projects: Minimum Standards
333‑010‑0770
Dental Pilot Projects: Informed Consent
333‑010‑0780
Dental Pilot Projects: Pilot Project Evaluation and Monitoring by Sponsor
333‑010‑0790
Dental Pilot Projects: Authority Responsibilities
333‑010‑0800
Dental Pilot Projects: Project Modifications
333‑010‑0810
Dental Pilot Projects: Discontinuation or Completion of Project
333‑010‑0820
Dental Pilot Projects: Suspension, Denial or Termination of Project
Last Updated

Jun. 8, 2021

Rule 333-010-0175’s source at or​.us