Bill > HB3342

This bill establishes the "Oklahoma Medicaid Audit Bill of Rights Act" to provide protections for health care providers when their claims submitted to Medicaid are audited. Key provisions include requiring auditors to give health care providers at least one week's advance notice before an audit begins, ensuring that audits involving professional judgment are conducted by or with consultation from a provider of the same specialty, and clarifying that simple clerical or recordkeeping errors will not be considered fraud. The bill also limits the scope of audits, generally restricting them to a maximum of fifty claims or 0.25% of claims billed in the previous year, and prohibits auditors from using a practice called "extrapolation," which is a method of projecting overpayments based on a sample of claims, to calculate recoupments or penalties. Furthermore, it mandates that recoupments only occur after a claim is corrected and limits them to the actual overpaid amount, unless the overpayment is part of a settlement, and establishes an appeals process for providers to challenge audit findings before any funds are recouped.

Health and Social Services

http://www.oklegislature.gov/BillInfo.aspx?Bill=hb3342&Session=2600