(Effective January 1, 2027)
PDFWAC 182-40-0900
Hospital overpayments.
(1) When the authority determines a contractor has reimbursed a hospital an amount in excess of the payment threshold for any plan year, as specified in WAC 182-40-0300, it is an overpayment. When the authority identifies an overpayment, the authority provides to the contractor written notice of noncompliance and assessment of the overpayment owed by the contractor.
(2) When the authority determines a contractor failed to meet the requirements under WAC 182-40-0300 for consecutive plan years due to making overpayments, the authority may also assess a fine according to WAC 182-40-1400.
(3) The authority may also require the contractor to create a corrective action plan or demonstrate corrective action. See WAC 182-40-1200.
(4) Nothing in this chapter prevents a contractor from seeking to recoup overpayments from hospitals.