Louisiana Revised Statutes 46:440.16 – Contractor performance oversight; penalties; protections
Terms Used In Louisiana Revised Statutes 46:440.16
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:440.12
- Oversight: Committee review of the activities of a Federal agency or program.
- Provider: means any healthcare entity enrolled with the department as a provider in the Medicaid program. See Louisiana Revised Statutes 46:440.12
- Recovery: means the recovery of overpayments, damages, fines, penalties, costs, expenses, restitution, attorney fees, or interest or settlement amounts. See Louisiana Revised Statutes 46:437.3
A. If more than twenty-five percent of the contractor’s adverse determinations are overturned on appeal in any six-month period, then the House Committee on Health and Welfare and the Senate Committee on Health and Welfare, jointly, shall hold an oversight hearing to evaluate the contractor’s performance and provide the medical assistance program with direction related to corrective action plans and future reevaluation of performance.
B. The department shall, with input from healthcare providers and in accordance with the Administrative Procedure Act, promulgate rules relative to appropriate and inappropriate determinations by recovery audit contractors, and to establish penalties and sanctions to be associated with inappropriate determinations by those contractors.
C. If the department or the hearing officer in a formal appeal finds that the recovery audit contractor’s determination was unreasonable, frivolous, or without merit, then the contractor shall reimburse to the provider the provider’s costs associated with the appeals process.
Acts 2014, No. 568, §1, eff. Aug. 15, 2014.