A. 1. The Oklahoma Health Care Authority shall establish a method to deter abuse and reduce errors in Medicaid billing, payment, and eligibility through the use of technology and accountability measures for the Authority, providers, and consumers. The Authority shall achieve a payment error rate measurement of no greater than five percent (5%) by fiscal year 2009. The Oklahoma Health Care Authority shall evaluate and report findings to the Governor and the Legislature.
2. For the purposes of this section, “error rate” means errors based on clearly defined objective documentation standards that are readily available to providers. Training to meet the standards shall be provided on at least an annual basis by the Oklahoma Health Care Authority.
B. 1. If errors are suspected to be the result of fraudulent acts, the errors shall be reported and investigated by the Oklahoma Attorney General.
2. Recoupment of overpayments due to identified errors determined not to be fraudulent and shall occur only after the provider has had the opportunity to exercise the right to an appeal that shall include a hearing conducted by an administrative law judge appointed by the Oklahoma Attorney General. The provider shall have the right to participate in the hearing and to be represented by legal counsel.
C. The Oklahoma Health Care Authority shall evaluate and report findings concerning the limited use of the extrapolation method to the Governor and the Legislature.
Added by Laws 2006, c. 315, § 9, emerg. eff. June 9, 2006. Amended by Laws 2010, c. 375, § 1, eff. Nov. 1, 2010.
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