Recoupment

  1. Law
  2. Arkansas Code
  3. Public Health and Welfare
  4. Social Services
  5. Medical Assistance
  6. Medicaid Fairness Act
  7. Recoupment

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  1. (a)

    1. (1) The Department of Human Services shall not use a technical deficiency as grounds for recoupment unless identifying the technical deficiency as an overpayment is mandated by a specific federal statute or regulation or the state is required to repay the funds to the Centers for Medicare & Medicaid Services, or both.

    2. (2) When recoupment is permitted, the department shall not recoup until there is a final determination identifying the funds to be recouped as overpayments.

  2. (b)

    1. (1) The department shall recognize that an error or omission is a technical deficiency if:

      1. (A) The error or omission meets the definition of “technical deficiency” in § 20-77-1702;

      2. (B) The error or omission involved a covered service; and

      3. (C) The provider can substantiate through other documentation that the medical assistance was provided.

    2. (2) Other documentation under subdivision (b)(1)(C) of this section shall be:

      1. (A) In accord with generally accepted healthcare practices; and

      2. (B) Contemporaneously created.

    3. (3) Other documentation under subdivision (b)(1)(C) of this section is not required to be equivalent in form to, nor required to duplicate, the documentation containing the error or omission, if all the documentation taken together establishes that the claim is payable.

  3. (c) This section does not preclude a corrective action plan or other nonmonetary measure in response to technical deficiencies.

  4. (d)

    1. (1) If a provider fails to comply with a corrective action plan for a pattern of technical deficiencies, then appropriate monetary penalties may be imposed if permitted by law.

    2. (2) However, the department first must be clear as to what the technical deficiencies are by providing clear communication in writing or a promulgated rule when required.

  5. (e) The department shall not issue a recoupment on a minor omission such as a missing date or signature if the requirements of this section are met.

  6. (f) The department shall not rely on the denial of one claim as the sole basis for the denial of a subsequent claim and shall establish that the subsequent claim is deficient.


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