§ 20-77-1304 - Claims review and administrative sanctions.
20-77-1304. Claims review and administrative sanctions.
(a) (1) Pursuant to rules and regulations promulgated in accordance with the Arkansas Administrative Procedure Act, 25-15-201 et seq., the Director of the Department of Human Services shall establish a process to review a claim made by a health care provider to determine whether the claim should be or should have been paid as required by federal or state law or rule.
(2) Claims review may occur prior to or after payment is made to a health care provider.
(3) The director may withhold payment to a health care provider during claims review if necessary to protect the fiscal integrity of the medical assistance programs provided that the health care provider has an opportunity for a hearing within sixty (60) days of the date payment is withheld.
(b) (1) The director may establish various types of administrative sanctions pursuant to rules and regulations promulgated in accordance with the Arkansas Administrative Procedure Act, 25-15-201 et seq., which may be imposed on a health care provider or other person who violates any provision of this subchapter or any other applicable federal or state law or rule related to the medical assistance programs.
(2) Administrative sanction shall include any or all of the following: recoupment, posting of bond or other security, or a combination thereof; exclusion as a health care provider; or liquidated damages.
(c) (1) The Department of Human Services shall conduct a hearing in compliance with the Arkansas Administrative Procedure Act, 25-15-201 et seq., at the request of a person who wishes to contest an administrative sanction imposed on him or her by the director.
(2) A party aggrieved by an order may seek judicial review in accordance with the Arkansas Administrative Procedure Act, 25-15-201 et seq.
(3) Judicial review of the order shall be conducted in compliance with the Arkansas Administrative Procedure Act, 25-15-201 et seq.
(d) All state rules and regulations issued on or before July 30, 1999, shall be deemed to have been issued in compliance with the authority of this section.