ARTICLE 5.3. Audit, Appeal, and Recovery of Overpayments
Article 5.3 added by Stats. 1977, Ch. 1046.
§§ 14170–14178 · 19 sections
- § 14170 (a) (1) Amounts paid for services provided to Medi-Cal beneficiaries shall be audited by the department in the manner and form prescribed by the department.…
- § 14170.1 (a) Prior to the issuance to a provider of pharmaceutical services of any demand for payment pursuant to an audit or examination conducted under Sections 10722…
- § 14170.5 (a) No provider’s claims for reimbursement under this chapter shall be subject to any special claims review procedure for a period in excess of nine months…
- § 14170.8 (a) Notwithstanding any other provision of law, every primary supplier of pharmaceuticals, medical equipment, or supplies shall maintain accounting records to…
- § 14170.10 (a) No provider shall submit a claim to the department or its fiscal intermediaries for the dispensing or furnishing of a controlled drug, a dangerous drug, or…
- § 14170.11 (a) No person or entity shall submit a claim to the department or its fiscal intermediaries for reimbursement under the Medi-Cal program for a nerve conduction…
- § 14170.12 Effective January 1, 2012, and notwithstanding Section 19130 of the Government Code, the State Department of Health Care Services may enter into contracts with…
- § 14171 (a) The director shall establish administrative appeal processes to review grievances or complaints arising from the findings of an audit or examination made…
- § 14171.5 Any institutional provider of health care services that obtained reimbursement under this chapter to which it is not entitled shall be subject to the following…
- § 14171.6 (a) (1) Any provider, as defined in paragraph (3), that obtains reimbursement under this chapter to which it is not entitled shall be subject to interest…
- § 14172 (a) Except as provided in subdivision (b), if any amount is due and payable and unpaid as the result of an overpayment to a provider of health care services,…
- § 14172.5 (a) No later than 60 days after the completion of an audit or examination pursuant to Sections 10722 and 14170, the department shall issue the first statement…
- § 14173 An abstract of a judgment obtained pursuant to subdivision (a) of Section 14172 or a copy thereof may be recorded with the county recorder of any county. From…
- § 14174 The right of the director to use the summary judgment procedure contained in this article shall be in addition to any other collection procedure available to…
- § 14175 The director may release any lien imposed pursuant to subdivision (a) of Section 14172 if he finds that the liability represented by the lien, including any…
- § 14176 The director may recover a due and payable overpayment made to a provider which is or has been participating under the provisions of this chapter by means of a…
- § 14176.5 Whenever it has been determined, pursuant to an audit conducted by the department, that an overpayment for Medi-Cal services has been made to a hospital for…
- § 14177 When it has been determined that a provider of health care services participating under the provisions of this chapter has received an overpayment which is due…
- § 14178 (a) Counties shall be held harmless in accordance with the provisions of this section for state funds to be recouped pursuant to audit exceptions issued for…