Filetype Excel XLSX | Posted on 10 Aug 2022 | 3 years ago
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254x Filetype XLSX File size 0.09 MB Source: www.oregon.gov
Sheet 1: Summary of Fraud and Abuse
| Reporting Period (Quarter) | ||||||||||||
| CCO Name | ||||||||||||
| Quarterly Fraud and Abuse Activity Report CCO Recovery Summary by Quarter |
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| Q1 Recoveries | Q2 Recoveries | Q3 Recoveries | Q4 Recoveries | YTD Recoveries | ||||||||
| Recovery Category | Dollar Amount | Identified $ | Recovered $ | Identified $ | Recovered $ | Identified $ | Recovered $ | Identified $ | Recovered $ | Identified $ | Recovered $ | |
| Medicaid Health Plan Initiated Audit Recoveries | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| OHA Referral Recoveries | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Settlement Dollars Recovered | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Dental | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Non Emergent Medical Transportation | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Behavioral Health | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - FQHC, RHC, TC | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Pharmacy | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Total | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Quarterly Fraud and Abuse Activity Report CCO-administered Sanctions and Fines Summary by Quarter |
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| Q1 Sanctions/Fines | Q2 Sanctions/Fines | Q3 Sanctions/Fines | Q4 Sanctions/Fines | YTD Sanctions/Fines | ||||||||
| Recovery Category | Dollar Amount | Imposed $ | Received $ | Imposed $ | Received $ | Imposed $ | Received $ | Imposed $ | Received $ | Imposed $ | Received $ | |
| Sanctions | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Fines | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Other | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Dental | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Non Emergent Medical Transportation | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $1,000.00 | ||
| Provider - Behavioral Health | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - FQHC, RHC, TC | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Provider - Pharmacy | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Total | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $1,000.00 | ||
| Field Name | Description |
| Reporting Fiscal Year | State Fiscal Year in YYYY-YY format (ex: 2017-18) |
| Reporting Fiscal Quarter | Quarter in State Fiscal Year QQ format (ex: Q1) |
| CCO Internal Tracking Number | Identifier used by the CCO to monitor the case or audit |
| Provider Type | Medicaid provider type |
| Provider Tax ID | Provider's tax ID number |
| Provider/Entity Name | Full name of Provider or the Entity being reported (including any known "d/b/a") |
| Entity Medicaid ID Number | Provider's DMAP ID number |
| Provider NPI Number (If Applicable) | Provider's National Provider Identifier number |
| Date Detected | Date issue was first detected by the CCO in format MM/DD/YYYY |
| Date First Reported to OHA | Date the CCO first reported the issue in format MM/DD/YYYY |
| Allegation Type | Indicate whether Fraud or Abuse allegation |
| Primary Allegation | Main type of fraud or abuse category being alleged |
| Secondary Allegation (If Applicable) | Secondary type of fraud or abuse category being alleged |
| Detection Tool | Indicate tool plan used to detect issue |
| Preliminary Overpayment Identified | Total preliminary overpayment identified through CCO's audit/recovery activity |
| Final Overpayment Identified for Recovery | Total final overpayment identified through CCO's audit/recovery activity |
| Fines and Sanctions Amount (If Applicable) | Total amount of all fines and/or sanctions the CCO imposed on provider |
| Settlement Amount (If Applicable) | Total amount of settlement agreement between the CCO and provider |
| Recoupment Amount (If Applicable) | Total recovered from provider through CCO's audit/recovery activity to date |
| Dollar Amount Lost (If Applicable) | Total lost from provider (CCO's exposure that will not be recovered) |
| Status | Select from either Open or Closed status with details of where in process open investigation/audit is, or what closed outcome is |
| Other Entity Reported to | Complete list of entities plan has reported complaint to, including MFCU, ODHS, HHS/OIG, etc. |
| Corrective Action | Type of action the CCO has taken against provider to address issue |
| Number of Times Provider Reviewed Within Last 5 Years | Number of times the CCO has reviewed, audited, or investigated the reported provider during the last 5 year period |
| Detailed Update | Free-form narrative from the CCO that must include detailed information related to the progression of the CCO's review/investigation. This should be updated every reporting quarter to show the CCO's review is not stagnant. |
| Additional Comments | All other details the CCO wishes to include that are not captured elsewhere or that need further explanation |
| CCO Name | |||||||||||||||||||||||||
| Reporting Fiscal Year | Reporting Fiscal Quarter | CCO Internal Tracking Number | Provider Type | Provider Tax ID | Provider/Entity Name | Entity Medicaid ID Number | Provider NPI Number (If Applicable) | Date Detected | Date First Reported to OHA | Allegation Type | Primary Allegation | Secondary Allegation (If Applicable) | Detection Tool | Preliminary Overpayment Identified | Final Overpayment Identified for Recovery | Fines and Sanctions Amount (If Applicable) | Settlement Amount (If Applicable) | Recoupment Amount (If Applicable) | Dollar Amount Lost (If Applicable) | Status | Other Entity Reported to | Corrective Action | Number of Times Provider Reviewed Within Last 5 Years | Detailed Update | Additional Comments |
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