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BAM 710 1 of 2 MA OVERPAYMENTS BPB 2026-009 4-1-2026

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

DEPARTMENTAL POLICY MA Only Local office staff initiate a referral to the Office of Inspector General (OIG) when an overpayment (OP) appears to result from a suspected intentional program violation (IPV) by an individual eligible soley for Medicaid; see Bridges Administrative Manual (BAM) 700. Proceed as follows: • Determine the overpayment period and amount. • Evaluate the potential overpayment for suspected IPV; see BAM 720 for IPV criteria. If the potential overpayment meets IPV criteria an Overpayment Referral must be completed in Bridges, ensure Yes is checked for Suspected IPV to route the referral to OIG. Exception: Do not recoup OPs resulting from hearing decisions upholding MDHHS regarding the level of long-term care. PROCEDURES Document decisions and actions in case comments. A manager must review the case record. MA Payment Information Requests for MA payment information must be done by OIG. If an IPV is suspected contact OIG to request MA payment information. Overpayment Determination When the amount of MA payments is received, determine the OP amount. For an OP due to unreported income or a change affecting need allowances: • If there would have been a deductible or larger deductible, the OP amount is the correct deductible (minus any amount already met) or the amount of MA payments, whichever is less.

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Official source

BAM 710 1 of 2 MA OVERPAYMENTS BPB 2026-009 4-1-2026

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

DEPARTMENTAL POLICY MA Only Local office staff initiate a referral to the Office of Inspector General (OIG) when an overpayment (OP) appears to result from a suspected intentional program violation (IPV) by an individual eligible soley for Medicaid; see Bridges Administrative Manual (BAM) 700. Proceed as follows: • Determine the overpayment period and amount. • Evaluate the potential overpayment for suspected IPV; see BAM 720 for IPV criteria. If the potential overpayment meets IPV criteria an Overpayment Referral must be completed in Bridges, ensure Yes is checked for Suspected IPV to route the referral to OIG. Exception: Do not recoup OPs resulting from hearing decisions upholding MDHHS regarding the level of long-term care. PROCEDURES Document decisions and actions in case comments. A manager must review the case record. MA Payment Information Requests for MA payment information must be done by OIG. If an IPV is suspected contact OIG to request MA payment information. Overpayment Determination When the amount of MA payments is received, determine the OP amount. For an OP due to unreported income or a change affecting need allowances: • If there would have been a deductible or larger deductible, the OP amount is the correct deductible (minus any amount already met) or the amount of MA payments, whichever is less.