1. (a) A potential overpayment occurs when a beneficiary, or the person acting on the beneficiary's behalf, has knowingly failed to report other health coverage under either of the following circumstances:

   1. (1) The other health coverage is of a type designated by the Department as not subject to post-service reimbursement, and the beneficiary who fails to utilize such other health coverage without good cause; or
   2. (2) The beneficiary has received services for which Medi-Cal paid, and the beneficiary also claimed and received payment through private health care coverage.

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Sections 14009, 14016.4 and 14024, Welfare and Institutions Code.

History

1. New section filed 4-13-93; operative 5-13-93 (Register 93, No. 16).