Section 2030.750  Purchased-Care/Fee-for-Service Invoicing and Auditing

a)         Fund recipients under fee-for-service/purchased-care contracts for program services shall submit invoices on formats and per schedules and deadlines as prescribed by the Department.

b)         The Department will conduct random sample audits of client records to determine if the services billed for were provided.

c)         The Department will conduct random sample post billing audits of client's eligibility and financial status and if such audit reveals that the recipient has billed for an ineligible client or has failed to pursue all sources of payment before billing the Department, the recipient shall return to the Department all monies paid on behalf of such ineligible or financially able client.

d)         The Department will conduct random sample post billing audits of client record completeness.  Incomplete records may result in payment disallowances and subsequent recovery by the Department.

e)         Purchased-care/fee-for-service funds which the Department determines are being improperly held or have been misspent are subject to payback to the Department or offset to future payments, and are subject to recovery under the Grant Funds Recovery Act.