Section 47.05.200. Annual audits.

   (a) The department shall annually contract for independent audits of a statewide sample of all medical assistance providers in order to identify overpayments and violations of criminal statutes. The audits conducted under this section may not be conducted by the department or employees of the department. The number of audits under this section may not be less than 50 each year. The audits under this section must include both on-site audits and desk audits and must be of a variety of provider types. The department may not award a contract under this subsection to an organization that does not retain persons with a significant level of expertise and recent professional practice in the general areas of standard accounting principles and financial auditing and in the specific areas of medical records review, investigative research, and Alaska health care criminal law. The contractor, in consultation with the commissioner, shall select the providers to be audited and decide the ratio of desk audits and on-site audits to the total number selected. In identifying providers who are subject to an audit under this section, the department shall attempt to minimize concurrent state or federal audits.
   (b) Within 90 days after receiving each audit report from an audit conducted under this section, the department shall begin administrative procedures to recoup overpayments identified in the audits and shall allocate the reasonable and necessary financial and human resources to ensure prompt recovery of overpayments unless the attorney general has advised the commissioner in writing that a criminal investigation of an audited provider has been or is about to be undertaken, in which case, the commissioner shall hold the administrative procedure in abeyance until a final charging decision by the attorney general has been made. The commissioner shall provide copies of all audit reports to the attorney general so that the reports can be screened for the purpose of bringing criminal charges. The department may assess interest and penalties on any identified overpayment. Interest under this subsection shall be calculated using the statutory rates for postjudgment interest accruing from the date of the issuance of the final agency decision to recoup overpayments identified in the audit. In this subsection, the date of issuance of the final agency decision is the later of the date of
        (1) the department's written notification of the decision and the provider's appeal rights; or
        (2) if timely appealed by the provider, a final agency decision under AS 44.64.060.
   (c) Each fiscal year, the state's share of recovered overpayments obtained because of the required contract audits under this section shall be deposited with the commissioner of revenue under AS 37.10.050 and separately accounted for by the commissioner of administration under AS 37.05.142. The legislature may appropriate a portion of the estimated balance in the account to the department to pay for the annual audits described in this section.
   (d) As a condition of obtaining payment under AS 47.07 and AS 47.08 and for purposes of this section, a provider shall allow
        (1) the department reasonable access to the records of medical assistance recipients and providers; and
        (2) audit and inspection of the records by state and federal agencies.
   (e) This section does not preclude the department from performing audits that are allowed or required under other laws.

Authorities

47.05.235;47.05.290;47.07.076

Notes

Recent Bills that will modify this

HB 148 MEDICAL ASSISTANCE COVERAGE; REFORM
HB 219 MEDICAL ASSISTANCE EXPANSION AND AUDIT
HB 227 MEDICAL ASSISTANCE REFORM
SB 74 MEDICAID REFORM;TELEMEDICINE;DRUG DATABAS
SB 78 MEDICAL ASSISTANCE COVERAGE; REFORM

Implemented As

7 AAC 105.260
7 AAC 105.470
7 AAC 105.480
7 AAC 105.490
7 AAC 160.100
7 AAC 160.110
7 AAC 160.130

References

7 AAC 10.955
AS 47.05.235 Duty to identify and repay self-identified overpayments.
AS 47.05.290 Definitions.
AS 47.07.076 Reports to legislature.

History

(Sec. 3 ch 66 SLA 2003; am Sec. 40, 41 ch 25 SLA 2016)