4 AAC 64.070. Wrongfully obtained benefits; repayment; sanctions

(a) If the department has reasonable evidence of wrongfully obtained benefits by a provider, the department will conduct a preliminary review of the provider's records.

(b) If, as a result of the preliminary review, the department determines that an investigation is warranted, the department will send written notification of an investigation to the provider.

(c) A provider may continue to participate in the program during a review or investigation under this section. If a review or investigation results in no finding of wrongfully obtained benefits, the department will close the file for the case and will notify the provider of the file closure.

(d) If, after an investigation, the department determines that benefits were wrongfully obtained, the provider shall repay the amount wrongfully obtained under a repayment plan established with the department. If a participating provider defaults on a repayment plan, the provider is suspended from program participation for the remainder of the provider's existing grant period except that if the payments are brought current during the existing grant period, and unless a sanction under (e) of this section is also in effect, the provider will be reinstated for the remainder of that grant period. If a provider is in default on a repayment plan, the provider is ineligible to apply for a grant.

(e) In addition to the sanctions in (d) of this section, the provider is subject to the following sanctions:

(1) for a first violation, the provider is suspended from program participation for a period of two months, regardless of whether the amount wrongfully obtained has been, or is being, repaid;

(2) for a second violation, the provider's existing grant is terminated and the provider is permanently ineligible to apply for a grant, regardless of whether the amount wrongfully obtained has been, or is being, repaid.

(f) If a provider refuses to cooperate during a review or investigation under this section, the department will, in its discretion,

(1) suspend the provider from program participation during the remainder of the provider's existing grant period; or

(2) terminate the provider's existing grant; if the provider's existing grant is terminated under this paragraph, the provider is permanently ineligible to apply for a grant.

(g) A provider whose grant is terminated under this section shall return all unexpended grant money.

History: Eff. 9/12/97, Register 143

Authority: AS 14.07.060

AS 14.38.160

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