11123 Time Frames

The date of discovery for purposes of tracking timely claims shall be the date the case is first identified as potentially having overstated eligibility by the worker, quality assurance, or by other means.

For agency and client errors (see 11121.1 and 11121.2 ), the agency is required to prepare the claim and initiate recovery or attempt to initiate recovery by the end of the calendar quarter in which the overstated eligibility is first identified.

For fraud errors (see 11121.3 ), the agency is required to prepare the claim and initiate referral to the Office of the Medicaid Inspector General for prosecution by the end of the calendar quarter following the calendar in which the overstated eligibility is first identified.

NOTE : Failure to establish a claim within the time frames identified above does not negate the responsibility of the agency to establish or collect on the claim, or of the client to repay any valid overstated eligibility.