Section 7 AAC 105.480 - Withholding of payments(a) The department may temporarily withhold medical assistance payments to a provider under 7 AAC 105.410, in whole or in part, upon receipt of reliable information that the circumstances giving rise to the need for the withholding involve medical assistance fraud as defined in AS 47.05.210. Regardless of whether it elects to withhold payments under this section, the department will refer the information described in this subsection to the Department of Law.(b) Separate from any notice the department issues under 7 AAC 105.440, the department will send written notice to a provider before it withholds payment under this section. In the notice, the department will (1) state that payments are being withheld in accordance with 42 C.F.R. 455.23 or an applicable provision of state law;(2) state that the withholding is for a temporary period;(3) specify, when appropriate, each type of medical assistance claim to which the withholding applies;(4) specify, when appropriate, general allegations that justify the withholding action;(5) cite the circumstances under which the withholding will be terminated; and(6) inform the provider of the right to submit written evidence for consideration by the department.(c) The withholding of payments to a provider under this section does not preclude the department from imposing other sanctions against the provider under 7 AAC 105.400 - 7 AAC 105.470.(d) The department will cease withholding payments under this section after the department, or a prosecuting authority, determines that there is insufficient evidence to support allegations of fraud against the provider or after legal proceedings against the provider related to the allegations are completed in the provider's favor on all charges or claims.Eff. 2/1/2010, Register 193Authority:AS 47.05.010
AS 47.05.200
AS 47.05.210
AS 47.05.220
AS 47.07.040
AS 47.07.074