Effective 28 Aug 1996

630.460. Overpayment, defined — overpayment reimbursement request by department, procedure, review procedure — interest, amount, when — collection of overpayment, attorney general. — 1. For the purposes of this section, the term "overpayment" means any payment by the department to a vendor providing care, treatment, habilitation or rehabilitation services to clients under contract with the department, which is:

(1) In excess of the contracted rate less payments by the client or on his behalf as required to be made by the standard means test contained in department rules;

(2) In payment of services not provided;

(3) In payment for any service not authorized in the contract with the department; or

(4) In payment for services provided contrary to the provisions of the contract with the department.

2. The department shall notify the vendor in writing by certified mail, return receipt requested, of the amount of the overpayment, the basis for such overpayment and request reimbursement. Within thirty days of receipt of the notice of overpayment, a provider may request a review of the overpayment and reimbursement request by the department director or his designee. Such review shall be conducted in person if requested by the provider. The department director or his designee shall review the overpayment within fifteen days of the request for review.

3. If any overpayment is not fully repaid within forty-five days of the date of notice of overpayment, the department shall assess interest on the unpaid balance. Interest shall be charged on any unpaid balance beginning from the date of notice of overpayment and shall accrue at a rate not to exceed the annual rate established pursuant to the provisions of section 32.065, plus three percentage points.

4. The department and the vendor shall have forty-five days from receipt of the notice of the overpayment to negotiate a repayment plan to recover the amount of the overpayment as finally determined plus accrued interest at the rate established in subsection 3 of this section over a period determined by the department, but not to exceed twelve months from the date of final disposition of any overpayment review authorized by this section. The department shall determine the method of repayment which may include direct payment by the vendor, deduction from future amounts due to the vendor from the department, or both.

5. If any overpayment plus accrued interest not subject to a repayment plan pursuant to subsection 4 of this section is not fully repaid within six months of the date of notice of overpayment, the department may certify the amount due to the office of the attorney general, or take other appropriate collection actions. If any portion of an overpayment plus accrued interest which is subject to a repayment plan pursuant to subsection 4 of this section, but which is not repaid pursuant to the terms of the plan, the department may certify all or a portion of the overpayment plus accrued interest due to the office of the attorney general, or take other appropriate collection actions.

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(L. 1984 S.B. 575, A.L. 1996 H.B. 1081)