7 AAC 43.1800. Recovery of Medicaid expenditures

(a) The department will issue a written recovery notice to an individual, and will seek to recover Medicaid expenditures from that individual, if the Medicaid expenditures are made on behalf of that individual, and if that individual

(1) is determined, under 7 AAC 43.1810(d), to have

(A) committed an intentional program violation that resulted in Medicaid expenditures for which the individual was not entitled;

(B) committed program abuse that resulted in misuse or overuse of Medicaid benefits; or

(i) giving rise to an offense under AS 11, AS 17.30.080 , or AS 47.05.210 for which the individual was convicted; and

(ii) related to the obtaining of Medicaid benefits;

(2) has waived a hearing available under 7 AAC 43.1810(a)(2) or (b)(2);

(3) has signed a disqualification consent agreement, confirmed by a court, in which the individual admits committing an intentional program violation or program abuse, and agrees to being disqualified to receive Medicaid benefits; or

(4) received continued benefits pending a hearing under 7 AAC 49 and the hearing decision upheld the original denial or case closure.

(b) In a recovery notice issued under (a) of this section, the department will notify the individual of

(1) the finding of the court or hearing authority;

(2) the total Medicaid expenditures made on behalf of the individual, and for which the department seeks reimbursement;

(3) that repayment is required; and

(4) the need to schedule a meeting with the department in order to negotiate a repayment schedule.

(c) The department will issue a written notice of noncompliance to an individual who has received a recovery notice, and who fails to

(1) negotiate a repayment schedule in good faith; or

(2) comply with a negotiated repayment schedule.

(d) In a notice of noncompliance issued under (c) of this section, the department will demand payment in full within 30 days after the date of receipt of the notice. The department will consider an individual who does not pay the amount in full within 30 days to be in default. An individual in default is not eligible for Medicaid until the department determines that the individual is no longer in default. The department will pursue available legal remedies to recover from the income or resources of the individual in default.

(e) If the department determines that an individual, or a member of the individual's household, will suffer extreme hardship if the individual is required to repay the amount required in (b) of this section, the department will do one or more of the following:

(1) allow the individual to repay less than the total amount;

(2) reduce the monthly payment amount by lengthening the negotiated repayment schedule;

(3) temporarily suspend repayment.

(f) The department may suspend its efforts to recover Medicaid expenditures from an individual if collection activities are no longer cost effective.

(g) An individual who wishes to dispute any action taken by the department under (a) - (e) of this section or the amount of Medicaid expenditures claimed for recovery under this section may request a hearing under 7 AAC 49.

History: Eff. 3/26/2003, Register 165; am 10/26/2003, Register 168

Authority: AS 47.05.010

AS 47.07.040

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