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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 36

Effective Month: March 2019 • An applicant willfully or unintentionally withheld information that impacted eligibility.

Underpayments An underpayment occurs when Medicaid has not paid its full share of a recipient’s medical expenses or managed care payments. All underpayments are to be corrected upon discovery. If the underpayment resulted from agency error, the error may be corrected retroactively. Underpayments resulting from recipient errors are corrected, but they are not corrected retroactively. Necessary adjustments are made effective with the next month a change can be made. For further discussion, refer to the policy on reinstatements in Chapter 101. Overpayments An overpayment occurs because the recipient was ineligible for a period during which he received Medicaid or CHIP, or because Medicaid paid more than its correct share of medical expenses or managed care payments or more for institutional cost of care than it should have. An overpayment may result from the following: • Suspected Fraud The ABD and MAGI application forms carry a warning about the penalty for giving false information, so that when the individual gives the information to complete the application and signs it, he has been put on notice about giving incorrect or incomplete information as well as the requirement to report changes. Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some benefit to which the individual is not entitled or to a benefit greater than that to which the individual is entitled. It includes any act that constitutes fraud under applicable federal or state law.