42 C.F.R. § 456.23
Post-payment review process
The agency must have a post-payment review process that—
(a) Allows State personnel to develop and review—
(1) Beneficiary utilization profiles;
(2) Provider service profiles; and
(3) Exceptions criteria; and
(b) Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.
Notes of Decisions
Cited in 4
cases, 1981–2006 · leading case: Cowan v. Myers, 187 Cal. App. 3d 968 (Cal. Ct. App. 1986).
Cowan v. Myers, 187 Cal. App. 3d 968 (Cal. Ct. App. 1986). “" ( 42 C.F.R. § 456.23 (b).) The Medi-Cal postservice utilization control audits are consistent with the Act.”
Margulis v. Myers, 122 Cal. App. 3d 335 (Cal. Ct. App. 1981). “” ( 42 C.F.R. § 456.23 .) In response to the federal requirements, California has created SUR which operates pursuant to certain provisions of the Welfare and Institutions Code and title 22 of the California Administrative Code.”
Maxi Drug North, Inc. v. Comm'r, New Hampshire Dep't of Health & Human Servs., 907 A.2d 974 (N.H. 2006). “14(f), and 42 C.F.R. § 456.23 , as well as the Medicaid provider enrollment agreement.”
HCA Health Servs. of Kansas, Inc. v. State, Sec'y of Kansas Dep't of Soc. & Rehab. Servs., 900 P.2d 838 (Kan. Ct. App. 1994). “42 C.F.R. § 456.23 (1992). Kansas law authorizes SRS to withhold payments, which are otherwise proper, when it has determined that the provider to whom payments are to be made has been overpaid.”
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