§17-1741-4 - Provider over-utilization or abuse.

§17-1741-4 Provider over-utilization or abuse.

         (a) If the findings of the review indicate possible abuse, the department shall conduct a full investigation.

         (b) In the event that the department is unable to determine whether the actions of a provider constitute improper medical practice, the department requests an opinion of the Hawaii Medical Association peer review committee.

         (c) When incorrect practices result in overpayment, the department shall:

(1) Notify the provider of any aberrances;
(2) Request the provider to take corrective action; and
(3) Establish a monitoring program of the provider's medicaid practice to ensure corrective measures have been introduced.

         (d) Any overpayment made by the medical assistance program shall require repayment by the provider. Payment on the provider's pending claims may be withheld in part or in whole to be applied to the overpayments previously made to the provider by the medical assistance program.

        [Eff 08/01/94 ] (Auth: HRS §346-14; 42 C.F.R. §§431.10, 456.12) (Imp: 42 C.F.R. §§455.13, 455.14, 455.15, 455.16)

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