From Oregon: OAR 410-120-1400

https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=306658

From Oregon:

1. How do you get your referrals to
   your MFCU (not so much the mechanics but, rather, whether you send them
   for them to review, you meet and discuss first, whether before the
   referral there is any collaboration?

Generally, we send via email with full summary and back up documentation. Higher level/priority cases…

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I am wondering if other states are looking into the national attention brought to light by a NYT article, (link: New
York Times Article), around Providence Health and Services system billing Medicaid members for Medicaid covered services. In Oregon, we are in communication with Providence, requesting the pertinent data from them to assess…

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I agree we need the clarity. What we find in Oregon is when a beneficiary commits fraud to obtain services, it is referred to local law enforcement as a “theft of services.” However, local law enforcement rarely takes the case and the provider is left without any support. The beneficiary walks with no consequence, only to continue to commit the fraud.

Dawn–as the Medicaid agency, we received the check from MFCU for the total amount (state and federal share). We have financial coding that is applied to the check and it routes the money appropriately. Our 64 accountant picks up the info from the coding and gets it on the 64 correctly. The state Medicaid is first made whole with the recovery.…

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Here you go from Oregon…this is the 2022 contract.

Folks,

Would like to know if your state publicly posts your final audits. Do you post them before or after all appeals are exhausted? And if you post, where?

Thank you all!

Fritz