Library: Policy
317:35-13-5. Overpayments
Issued 7-27-95
(a) Overpayments due to client error or county error. When it appears a medical payment has been made in error because the individual failed to provide correct information or the county failed to obtain complete or correct information, the county worker prepares a written summary of facts relating to such payment and submits it to the DHS State Office, Attention Family Support Services Division (FSSD). FSSD will follow up appropriately in cooperation with the staff in the OHCA.
(b) Overpayment due to State Office error, provider error or fiscal agent processing error. When it is determined that an incorrect payment has been made due to OHCA error, provider error or fiscal agent processing error, the procedures for correcting the payment errors are:
- (1) When the OHCA determines an overpayment has been made, automatic offset recoupment procedures are processed through the claims processing contractor. This process is followed when the overpayment is discovered by the OHCA or the fiscal agent.
- (2) When the local office receives information a medical provider has been overpaid, a memo is sent to the OHCA, giving the source of the information and a summary of the situation. The overpayment is recovered by the automatic recoupment process through the fiscal agent.
- (3) When the medical provider discovers they have been overpaid, the provider has two options. The provider may voluntarily repay the amount to the OHCA. OHCA will process a correction through its claims processing system. If the provider does not voluntarily refund the amount, but notifies the OHCA, OHCA will initiate a recoupment request.
(c) Restitution owed to the Agency. Title XIX benefits are not denied any person because of a debt of restitution owed in any program.
