635 RECOUPMENT: LEGAL ACTION SR 94-04, 04/94 (AAM-A)

Pursue recoupment regardless of whether or not a fraud referral is pending, is being investigated, or is being prosecuted by the Office of Special Investigations (OSI) or the Attorney General, unless instructed otherwise. The Attorney General’s Office is responsible for keeping the Department of Health and Human Services (DHHS) informed about court decisions in which DHHS has an interest.

The following applies when criminal proceedings are brought against the individual and a guilty verdict is rendered.

• follow the court order on the method and schedule of repayment,

• if the individual is fined and/or imprisoned and no repayment is ordered by the court,

- Pursue recoupment of financial assistance. See Part 631 , Recoupment of Financial Assistance. The failure of the court to order repayment does not prevent DHHS from pursuing recoupment action on its own, unless expressly prohibited by court order.

- Medical assistance cannot be recouped unless the Superior Court orders a recoupment.

The following applies when criminal proceedings are brought against the individual and a not guilty verdict rendered.

• Pursue recoupment of financial assistance. See Part 631 , Recoupment of Financial Assistance.

- The court determined the individual is not guilty of committing a criminal act. The verdict may not relate to whether an overpayment has been made or whether or not repayment to DFA is required. A court finding of innocence does not erase the existence of the overpayment.

• Medical assistance cannot be recouped unless the Superior Court orders a recoupment.