WAC 182-520-0005 Washington apple health fraud referrals and overpayments

WAC 182-520-0005 Washington apple health fraud referrals and overpayments.

Effective July 14, 2016.

  1. The agency or the agency's designee may refer a case to the office of fraud and accountability for a fraud investigation when it has reliable information that the person purposely misrepresented their circumstances in order to qualify for Washington apple health.
  2. When a fraud investigation reveals substantial evidence to support a finding of fraud, the case is referred for prosecution. The prosecuting attorney's office decides which cases will be prosecuted.
  3. When a referral results in a conviction, an overpayment amount for the cost of the apple health coverage is established.
  4. The person is responsible to pay the agency for the amount of overpayment established as a result of a fraud conviction.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.