Chapter 33 — Recoupments, Estate Recovery and Liens
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Governs Alabama Medicaid procedures for identifying, recovering, and enforcing repayment of misspent or recoverable Medicaid payments from recipients, providers, and estates; includes liens, time payment plans, civil actions, and appeals affecting recipients, authorized representatives, providers, and estates.
No material clinical or coverage changes in this revision.
Recoupment, Estate Recovery, Liens and Appeals
Recoupment, estate recovery, liens and appeals criteria
Procedures and conditions under which the Agency will pursue recoupment, estate recovery, liens, exemptions, and appeals.
If direct reimbursement is not made
- Time payment plan may be allowed upon sufficient justification: recipients must sign a promissory note not to exceed two years; providers must sign a promissory note not to exceed one year.
- Fiscal agent recoupment: if provider is payee and has received monies to be recouped, or if a provider fails to submit direct reimbursement or agree to/adhere to a time payment plan, the Agency's fiscal agent will recoup the excess amount from a future adjustment payroll.
- Civil actions: the Agency may initiate civil actions through the courts when administrative procedures do not resolve recovery of amounts owed.
Legal Citations and Age Thresholds
| 42 U.S.C. § 1396p | Federal statute authorizing estate recovery and liens |
| 42 C.F.R. § 433.36 | Federal regulation cited for estate recovery procedures |
Provider Recoupment, Time Payment Plans, and Civil Actions
Provider recoupment procedures
When the Agency identifies an expected recoupment amount it will send a letter to the provider outlining the allegations, the amount, and the specific dates when overpayment or recoverable benefits occurred; the provider may submit direct reimbursement or present evidence to rebut the recoupment. If no rebuttal is offered, the original assessment is presumed correct; failure to reimburse or arrange payment may result in fiscal agent recoupment from future adjustment payrolls.
- Agency sends recoupment letter stating allegations, amount, and dates of overpayment or recoverable benefits.
- Provider may submit direct reimbursement or present evidence to rebut; absent rebuttal the assessment is presumed correct.
- If provider does not reimburse or enter an approved payment plan, fiscal agent may recoup from future adjustment payrolls.
Time payment plans require promissory note
The Agency may permit time payment plans upon sufficient justification; providers must sign a promissory note not to exceed one year (recipients' promissory notes may not exceed two years).
- Recipient promissory note duration: not to exceed two years.
- Provider promissory note duration: not to exceed one year.
Civil actions for recovery
If administrative procedures (direct reimbursement, time payment plans, or fiscal agent recoupment) do not result in satisfactory resolution, the Agency may initiate civil actions through the courts to recover amounts owed.
- Civil actions are used when other procedures fail to achieve satisfactory resolution.
Definitions and Special Terms
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