Section 7.160.130. Appeal.

	(a)  A provider may appeal the findings of a final audit conducted under 7 AAC 160.110 and determinations of overpayment amount under the audit.  
	(b)  An appeal under this section must  
		(1) be made in writing and submitted to the Commissioner's Office, Department of Health and Social Services, P.O. Box 110601, Juneau, Alaska 99811-0601;  
		(2) be submitted to the commissioner no more than 30 days after the date of the letter transmitting the provider's final audit report;  
		(3) contain a description of the finding or determination being appealed, a copy of the determination, and the basis upon which the final audit report is challenged; and  
		(4) include all information and materials, including any new information that the provider requests the commissioner to consider in resolving the appeal.  
	(c)  The commissioner will review the information and materials submitted under (b) of this section and consider the following factors in reaching a decision on an appeal under this section:  
		(1) the provider's error rate in the audit;  
		(2) whether the provider has a prior history of similar audit findings and whether the previous findings were corrected;  
		(3) whether the provider received notice of noncompliance previously and whether the provider received training regarding the noncompliance;  
		(4) whether the provider submitted false or fraudulent information, or omitted material information, on the Medicaid claims to the department;  
		(5) whether the findings of the audit indicate that the provider poses a health or safety risk to recipients.  
	(d)  The commissioner's decision under this section is a final administrative decision. The department will notify the provider of the provider's right to appeal the final administrative decision to the superior court under the Alaska Rules of Appellate Procedure.  

Authorities

47.05.010;47.05.200;47.07.040

Notes

Reference

7 AAC 105.260
7 AAC 105.270
7 AAC 105.280

Authority

AS 47.05.010 AS 47.05.200 AS 47.07.040

History

Eff. 2/1/2010, Register 193