WAC 182-502A-0501: Program integrity—Entity self-audits

Link to law: http://apps.leg.wa.gov/wac/default.aspx?cite=182-502A-0501
Published: 2015

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WACs > Title 182 > Chapter 182-502A > Section 182-502A-0501











182-502A-0401    

182-502A-0601







Agency filings affecting this section







WAC 182-502A-0501









Program integrity—Entity self-audits.









(1) The agency may require an entity to self-audit. (a) The agency will give written notice of the instruction to self-audit. (b) The entity must acknowledge receipt of the notice within thirty calendar days of receiving it. (c) The entity must comply with all terms included in the notice; failure to timely comply with the notice constitutes failure to comply with a program integrity activity. (d) The agency will not require an entity to self-audit any services or encounters that are included in an active state or federal program integrity activity, rate adjustment, cost settlement, or other payment adjustment. (e) The agency will review the self-audit and state in writing whether it accepts or rejects the results of the self-audit. If the agency rejects the results it may: (i) Instruct the entity to repeat the self-audit; or (ii) Audit the entity. (2) An entity may initiate a self-audit at any time to verify payments made by the agency. When the entity's self-audit and identifies an overpayment, it must: (a) Submit to the agency written notice of the self-audit and identify each claim included in the self-audit. (b) Report and repay the overpayment to the agency within sixty calendar days of identifying the overpayment, unless the overpayment is one of the following: (i) Included in an active state or federal program integrity activity. (ii) Related to a state-initiated rate adjustment, cost settlement, or other payment adjustment. (c) The entity's overpayment report must include: (i) The reason for the overpayment; (ii) How the entity calculated the overpayment; and (iii) A list of claims associated with the overpayment. (d) The agency will review the self-audit and state in writing whether it accepts or rejects the methodology and findings. If the agency rejects the findings it may: (i) Instruct the entity to repeat the self-audit; or (ii) Audit the entity. (e) The agency will not accept any identified overpayment as full or final repayment before the completion of its review of the entity's self-audit findings. (3) The entity's dispute and appeal rights under this section are identical to its rights during an audit conducted by the office of program integrity. [Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-01-129, § 182-502A-0501, filed 12/19/14, effective 1/19/15.]