Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/22/2024
08000 >>> 08330
08320
08330 Overstated Eligibility and Claims - Overstated eligibility occurs when an individual receives more coverage than they are entitled to receive. Eligibility staff shall document how the overstated eligibility was determined and the reason case correction was required. All overstated eligibility must be promptly resolved.
8330 Time Frames - The date of discovery for purposes of tracking timely claims shall be the date the case is first identified as potentially having overstated eligibility by the worker, quality assurance, or by other means.
Failure to establish a claim within the time frames identified below does not negate the responsibility of the agency to establish or collect on the claim, or of the client to repay any valid overstated eligibility.
8331 - For agency and client errors, the agency is required to prepare the claim and initiate recovery or attempt to initiate recovery or attempt to initiate recovery by the end of the calendar quarter in which the overstated eligibility is first identified.
8332 - For fraud errors, the agency is required to prepare the claim and initiate a referral to the Office of the Medicaid Inspector General for prosecution by the end of the calendar quarter following the calendar quarter in which the overstated eligibility is first identified.