2019 Arkansas Code
Title 20 - Public Health and Welfare
Subtitle 5 - Social Services
Chapter 77 - Medical Assistance
Subchapter 1 - General Provisions
§ 20-77-125. Contingency Fee Audits Prohibited - Definitions
(a) As used in this section:
(1) “Healthcare provider” means a person enrolled to provide health or medical care services or goods authorized under Medicaid;
(2) “Medicaid” means the medical assistance program provided in this state under Title XIX of the Social Security Act of 1965, 42 U.S.C. § 1396 et seq., including components of the program;
(3) “Medicaid integrity audit contract” means a contract required under federal law between the Department of Human Services and a Medicaid integrity audit program contractor to:
(A) Review the actions of healthcare providers furnishing services or goods for which payment may be made under the Arkansas Medicaid Program to determine whether fraud, waste, or abuse has occurred or is likely to occur, or whether fraud, waste, or abuse has the potential for resulting in an expenditure of Medicaid funds that is not intended under the Arkansas Medicaid Program;
(B) Audit Medicaid claims to ensure proper payments were made; or
(C) Identify overpayments made to individuals or entities receiving Medicaid funds; and
(4) “Person” means any individual, company, firm, organization, association, corporation, or other legal entity.
(b) The Division of Medical Services of the Department of Human Services shall not enter into a Medicaid integrity audit contract that authorizes all or part of an auditor's compensation to be based, directly or indirectly, on the amount of overpayments identified or collected by the auditor.
(c)
(1) Within forty-five (45) days after April 11, 2013, the division shall seek a waiver from the Centers for Medicare & Medicaid Services of the requirement that recovery audit contractors, as identified in 42 U.S.C. § 1396a(a)(42)(B), be paid on a contingent fee basis by submitting an amendment to the Medicaid state plan to implement the requirements of this section.
(2)
(A) Except as under subdivision (c)(2)(B) of this section, this section does not apply to:
(i) A contract with a Medicaid integrity audit contractor entered into before the state plan amendment is approved by the Centers for Medicare & Medicaid Services; or
(ii) An existing contingent fee contract entered into before July 1, 2013.
(B) An existing contingent fee contract shall not be renewed from and after July 1, 2013, April 11, 2013, or the date a waiver from the Centers for Medicare & Medicaid Services becomes effective, whichever is later.
