超額付款專案
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The Third Party Liability and Recovery Division’s Overpayments program (OP) is responsible for enforcing fiscal compliance with Medi-Cal laws and regulations for Medi-Cal providers and beneficiaries. The primary function is to recover funds due the Medi-Cal program, thereby reducing the total cost of the program. Overpayment cases are referred by the Audits and Investigations Division (A&I), other auditing and legal agencies, and the Medi-Cal fiscal intermediaries (FI).
當發現提供者超額付款時，FI 會向供應商發送超額付款通知，或由稽核組織發送付款要求信件。 這些信函還通知供應商其上訴權。 如果提供者不自願付款，OP 可以採取措施讓 FI 抵消當前加州醫療補助健康保健計劃索賠付款中所欠的金額，讓聯邦醫療保險和醫療補助服務中心抵消聯邦醫療保險付款，尋求高等法院的法定判決，並記錄對提供者擁有的不動產和動產的留置權。
For beneficiary overpayments, the Department sends demand letters and makes phone calls seeking voluntary repayment. If these efforts are unsuccessful, OP may initiate offset of State Income Tax refunds and lottery winnings, pursue civil actions in Small Claims Court, or refer the case to the Attorney General’s Office to secure a judgment against the beneficiary’s assets and/or record a real property lien.
聯絡資訊
如要以電子方式向 OP 提交查詢，請填寫「超額付款網上表格」。
如要向 OP 遞交書面通訊，請使用以下郵寄地址。 請務必提供相關資訊，例如提供者號碼 (NPI) 和聯絡資訊：
Department of Health Care Services
Third Party Liability & Recovery Division
Overpayments Unit – MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425