California Welfare and Institutions Code ARTICLE 5.3 - Audit, Appeal, and Recovery of Overpayments

• Section 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. The department...
• Section 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...
• Section 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...
• Section 14170.8.
  (a) Notwithstanding any other provision of law, every primary supplier of pharmaceuticals, medical equipment, or supplies shall maintain accounting records to demonstrate the manufacture, assembly, purchase,...
• Section 14170.10.a.
  (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,...
• Section 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...
• Section 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 one...
• Section 14171.
  (a) The director shall establish administrative appeal processes to review grievances or complaints arising from the findings of an audit or examination made pursuant to Sections...
• Section 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...
• Section 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 charges...
• Section 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...
• Section 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...
• Section 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...
• Section 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...
• Section 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...
• Section 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...
• Section 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...
• Section 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...
• Section 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...

Last modified: October 22, 2018