The department:

1. (1) Must:

   1. (a) Deny third party liability claims:

      1. (i) That are not supported or substantiated by the evidence submitted;
      2. (ii) For items or amounts not covered or excluded by the terms, limitations, or exclusions of the third party liability reimbursement program;
      3. (iii) For ineligible placements; or
      4. (iv) When the property damages, personal injuries, or emergency medical expenses are misrepresented or willfully concealed by the licensed caregivers or other parties involved; and
   2. (b) Report third party liability claims found to be fraudulent involving theft or collusion involving public funds, per RCW 43.09.185; and

2. (2) May:

   1. (a) Recover payments made for third party liability claims that were determined to be ineligible; or
   2. (b) Refer third party liability claims found to be fraudulent involving theft or collusion involving public funds to the assistant attorney general and local law enforcement.

[Statutory Authority: RCW 74.13.031 and 74.14B.080. WSR 26-09-128, s 110-50-0980, filed 4/21/26, effective 5/22/26.]