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(a) Upon notice to a provider, the department may temporarily withhold medical assistance payments to a provider, in whole or in part, upon receipt of reliable information or evidence that the circumstances giving rise to the need for the withholding involve medical assistance fraud as defined in AS 47.05.210 . Regardless of whether it elects to withhold payments under this section, the department will refer the information or evidence described in this subsection to the Department of Law.
(b) The department will not impose a restriction under this section until the provider receives written notice of the department's intent to do so. The notice will
(1) state that payments are being withheld in accordance with 42 C.F.R. 455.23 or other applicable provision of state law;
(2) state that the withholding is for a temporary period;
(3) specify, when appropriate, each type of medical assistance claim to which the withholding applies;
(4) specify, when appropriate, general allegations that justify the withholding action;
(5) cite the circumstances under which the withholding will be terminated; and
(6) inform the provider of the right to submit written evidence for consideration by the department.
(c) The withholding of payments to a provider under this section does not preclude the department from imposing sanctions against the provider under 7 AAC 43.950 - 7 AAC 43.980.
(d) The department will cease withholding payments under this section after the department, or a prosecuting authority, determines that there is insufficient evidence to support allegations of fraud against the provider or after legal proceedings against the provider related to the allegations are completed.
History: Eff. 6/19/2004, Register 170
Authority: AS 47.05.010
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Last modified 7/05/2006