§ 1101.69a. Establishment of a uniform period for the recoupment of overpayments from providers (COBRA).
(a) For overpayments relating to cost reporting periods ending prior to October 1, 1985, which were not appealed prior to February 6, 1988, the Department will use its current policy specified in § § 1101.84(b)(4) and (5) and 1181.101(f) (relating to provider right of appeal; and facility’s right to a hearing).
(b) For overpayments relating to cost reporting periods ending on or after October 1, 1985, the Department will use the following recoupment procedure:
(1) If an analysis of the provider’s audit report and the Department’s payment records, by the Office of the Comptroller, discloses that an overpayment has been made, or if the provider notifies the Department in writing that an overpayment has occurred, the Office of the Comptroller will issue a letter to the provider notifying the provider of the amount of the overpayment. The letter will request that the provider contact the Office of the Comptroller within 15 days of the date of the letter to establish a repayment schedule. The provider’s invoices (MA 309C) will continue to be processed by the Department. The date of the cost settlement letter will serve as day one in determining relevant time frames.
(2) If the provider does not submit an acceptable repayment plan to the Department or fails to respond to the cost settlement letter within the specified time period, the Department will offset the overpayment amount against the provider’s pending MA payments until the overpayment is satisfied.
(3) An acceptable repayment schedule includes either direct payment to the Department by check from the provider or a request by the provider to have the overpayment offset against the provider’s pending claims until the overpayment is satisfied. To be acceptable, a direct repayment plan or an intermittent offset plan must ensure the total overpayment amount will be repaid to the Department no later than the date the Department must credit the Federal government with the Federal share of the overpayment. Under current Federal procedure, the overpayment would be due at the end of the calendar quarter during which the 60th day from the date of the cost settlement letter falls.
(4) The Department reserves the right to refuse to allow a direct repayment plan if a provider chose this method, but failed to remit payment as agreed for a previous overpayment. When the provider fails to remit payment, the Department will offset the overpayment against the provider’s MA payments until the overpayment is satisfied.
(5) The procedures in this subsection do not apply if the provider is bankrupt or out-of-business under section 1903(d)(2)(D) of the Social Security Act (42 U.S.C.A. § 1396b(d)(2)(D)).
(6) An appeal by the provider of the Department’s action to offset the overpayment against the provider’s MA payments when the provider fails either to respond timely to the cost settlement letter or to pay the overpayment directly when due will not stay the Department’s action.
(7) An appeal by the provider of the audit disallowance does not suspend the provider’s obligation to repay the amount of the overpayment to the Department. If the provider prevails in whole or in part in the appeal and is thereby owned money by the Department, the Department will refund money due the provider as a result of the provider’s appeal.
(c) For overpayments relating to cost reporting periods prior to October 1, 1985, which were appealed prior to February 6, 1988, the Department will apply § 1181.101(f) as effective prior to February 6, 1988, permitting stays of repayment pending the decision of the Office of Hearings and Appeals on the appeal of the underlying audit or overpayment, or both.
Source The provisions of this § 1101.69a adopted October 20, 1989, effective February 6, 1989, 19 Pa.B. 4543.
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
