WAC 182-600-0600

(1) When the health care authority (HCA) completes the review under WAC 182-600-0500, HCA may do any of the following:

(a) Deny and recover improperly paid claims;

(b) Instruct the LTSS provider to submit additional information or submit a new claim;

(c) Issue a final notice assessing an overpayment which the LTSS provider may appeal under WAC 182-600-0700;

(d) Refer an overpayment to the department of social and health services office of financial recovery for collection;

(e) Refer suspected fraud to law enforcement.

(2) LTSS providers must keep documentation to prove the services billed were delivered and payment was appropriate. Providers must retain all records supporting claims for a minimum of six years from the date of service, or longer if the law requires or an audit or investigation is in progress. Failure to keep this documentation may result in recoupment of the payment.