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Or. Admin. R. 410-120-1395 - Program Integrity
Link to the law
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Current as of June 2015
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The Department of Human Services utilizes a number of program integrity approaches related to provider payments, including:
- Medical review and prior authorization processes;
- Provider obligations to submit correct claims;
- Quality improvement activities; and
- Investigation of fraud prohibited kickback relationships
Providers are required to maintain clinical, financial and other records, capable of being audited or reviewed. Requests for services or items may be reviewed, and claims for care, services or items may be audited by DHS staff or a designee, a medical utilization and review contractor, a dental utilization and review contractor and/or a federal or state oversight authority.
Current as of June 2015
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