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(a) If, after a full investigation in accordance with 42 C.F.R. 455.15, the department believes an individual member of a household applying for or receiving Medicaid benefits has committed an intentional program violation or program abuse, the department may
(1) deny an application for Medicaid, subject to a hearing under 7 AAC 49;
(2) proceed with recovery of Medicaid expenditures in accordance with 7 AAC 43.1800, including a hearing under 7 AAC 49; and
(3) refer the matter to the appropriate authorities for civil or criminal action in a state or federal court.
(b) If an individual member of a household applying for or receiving Medicaid benefits has been convicted of an offense under AS 11, AS 17.30.080 , or AS 47.05.210 , and if the department believes that the conduct giving rise to the offense was related to the obtaining of Medicaid benefits, the department may
(1) deny an application for Medicaid, subject to a hearing under 7 AAC 49;
(2) proceed with recovery of Medicaid expenditures in accordance with 7 AAC 43.1800, including a hearing under 7 AAC 49; or
(3) exclude the individual from participation in Medicaid in accordance with AS 47.05.240 .
(c) The department will coordinate action taken under (a) or (b) of this section with any corresponding action being taken under 7 AAC 45 (Alaska Temporary Assistance Program) or 7 AAC 46 (Food Stamp Program), if the factual issues involved arise from the same or related circumstances.
(d) The department will seek recovery under 7 AAC 43.1800 from an individual if a hearing authority acting under 7 AAC 49 concurs with the department that
(1) the individual committed an intentional program violation or program abuse; or
(2) in the case of an individual who was convicted of an offense under AS 11 or AS 47.05.210 , the conduct giving rise to the offense was related to the obtaining of Medicaid benefits.
History: Eff. 3/26/2003, Register 165; am 10/26/2003, Register 168
Authority: AS 47.05.010
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Last modified 7/05/2006