State Member Kurt Kresta
State Member-
Kurt Kresta started the discussion Administrative terminations for criminal acts not involving Medicaid in the forum State Only Forum 2 years ago
Administrative terminations for criminal acts not involving Medicaid
Aloha NAMPI colleagues,
In Hawaii we have been challenged by our administrative hearing officers regarding termination of providers for criminal offenses not involving fraud or other Medicaid related offenses. They have ruled that the wording of our administrative rules does not specify we can terminate providers for other criminal offenses.…
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Kurt Kresta replied to the discussion Payment Suspension against 1 provider in group practice in the forum State Only Forum 2 years ago
Reply to Payment Suspension against 1 provider in group practice
Aloha,
We in Hawaii have had this situation a few times. We have chosen to suspend the payments to any claims with the suspended provider as the servicing provider. However, we recognize that allows the providers to simply bill under the group ID and not list the suspended provider as the servicing provider.
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Kurt Kresta replied to the discussion Civil case settlements in the forum State Only Forum 3 years ago
Reply to Civil case settlements
Aloha Dawn,
The amount of the overpayment is returned to the the Medicaid program and the federal share is refunded. Anything above that amount is usually retained by the MFCU as punitive damages. Sorry, I don’t know how it is recorded on CMS 64.
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Kurt Kresta replied to the discussion MCO Contracts and Program Integrity in the forum State Only Forum 3 years ago
Reply to MCO Contracts and Program Integrity
Aloha MayKay, you can find a copy of our contract (called RFP in Hawaii) at this link:
Our liquidated damages clauses are in section 14.21.
