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182-40-0800  <<  182-40-0900 >>   182-40-1000

(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.
[Statutory Authority: RCW 41.05.021, 41.05.160, and 41.05.028. WSR 25-24-066, s 182-40-0900, filed 12/1/25, effective 1/1/27.]