Or. Admin. Code § 333-004-4090 - Review or Audit of Abortion Access Plan Claims

(1) A RH Program staff person, contractor, or auditor may review a claim for assurance that:

(a) Specific medical services, drugs, devices, or supplies were provided to clients by an authorized agency or authorized provider in accordance with OAR 333-004-4040 (Client Eligibility); and

(b) The services, drugs, devices, or supplies were provided in accordance with Abortion Access Plan rules.

(2) To determine the number of inappropriate claims, and subsequently the overpayment amount, the RH Program may review a statistically valid random sample of claims with sufficient sample size for a confidence interval of 95 percent.

(3) The RH Program may deny payment or seek recovery of payment if a review or audit determines the visit does not include a covered services(s) referred to in OAR 333-004-4120 (Grounds for Sanctions; Sanctions).

(4) The RH Program shall notify the authorized agency or authorized provider, in writing, of the improper billing findings and subsequent actions to be taken by the authorized agency or authorized provider to correct the identified findings and any sanctions that may be imposed by the RH Program.

Notes

Or. Admin. Code § 333-004-4090

PH 47-2023, adopt filed 09/28/2023, effective 10/1/2023; PH 109-2024, minor correction filed 11/26/2024, effective 11/26/2024

Statutory/Other Authority: ORS 413.042 & ORS 435.230

Statutes/Other Implemented: ORS 413.032 & ORS 435.230