Overpayment

When a provider has billed for more units of service than the All Services Plan (ASP) authorizes, the Case Management Agency notifies the ODJFS Bureau of Home and Community Services. If the Bureau believes that an overpayment has occurred, we send an overpayment letter to give the provider the opportunity to either disagree with (and disprove) the alleged overpayment or repay the money owed.

If the provider does not respond to the overpayment letter, the Bureau:

• Issues a Notice of Operational Deficiency.
• Refers the provider to the Surveillance & Utilization Review Section to assist in the collection of the overpayment plus interest.

At any time during this process the Bureau can refer the provider to the Attorney General's Office to investigate Medicaid fraud.

If you have questions, contact the ODJFS Bureau of Home and Community Services, Standards and Services Section at 614-466-6742 or by e-mail at: BHCS@odjfs.state.oh.us.