R414-310-15. Improper Medical Coverage

  (1) Improper medical coverage occurs when:

  (a) an individual receives medical assistance for which the individual is not eligible, including benefits that the individual receives pending a fair hearing or during an undue hardship waiver if the enrollee fails to act as required by the eligibility agency;

  (b) an individual receives a benefit or service that is not part of the benefit package for which the individual is eligible;

  (c) an individual pays too much or too little for medical assistance benefits; or

  (d) the Department pays too much or too little for medical assistance benefits on behalf of an eligible individual.

  (2) An individual who receives benefits under PCN for which the individual is not eligible must repay the Department for the cost of the benefits that the individual receives.

  (3) An alien and the alien's sponsor are jointly liable for benefits that an individual receives for which the individual is not eligible.

  (4) An overpayment of benefits includes all amounts paid by the Department for medical services or other benefits on behalf of an enrollee, or for the benefit of the enrollee during a period in which the enrollee is not eligible to receive the benefits.