R30-1-7. Self-Audits

  (1) When billing concerns are identified, the office may send out a self-audit packet to a provider, which notifies the provider of:

  (a) the type of potential billing errors identified by the office;

  (b) a list of claims, which may have been billed incorrectly;

  (c) the policy, which describes how the claims should be billed;

  (d) instructions on conducting a self-audit;

  (e) information about refunding any payments the provider identifies as an overpayment; and

  (f) the period for conducting the self-audit and responding to the office.

  (2) Once the time for responding to the self-audit has passed, the office shall review any information received from a provider to determine if the provider has fully resolved the issues identified by the office.

  (3) If the office is not satisfied the provider fully addressed the concerns identified by the office, the office may:

  (a) contact the provider about the issues, which were not fully resolved;

  (b) conduct a full investigation and initiate a recovery action if appropriate; or

  (c) close the case.

  (4) Participation in the self-audit program does not preclude any entity from pursuing any criminal, civil, or administrative remedies or to obtain additional damages, penalties, or fines related to the subject of the self-audit.