The department:

1. (1) Will:

   1. (a) Deny caregiver reimbursement program 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 caregiver reimbursement program;
      3. (iii) For ineligible placements; or
      4. (iv) When the property damages, property loss, or emergency medical expenses are misrepresented or willfully concealed by caregivers or other parties involved; and
   2. (b) Report caregiver reimbursement program claims found to be fraudulent or involving theft or collusion involving public funds per RCW 43.09.185; and

2. (2) May:

   1. (a) Recover payments made for caregiver reimbursement program claims that were determined to be ineligible; or
   2. (b) Refer caregiver reimbursement program 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 74.13.335. WSR 26-09-128, s 110-50-1080, filed 4/21/26, effective 5/22/26. WSR 18-14-078, recodified as § 110-50-1080, filed 6/29/18, effective 7/1/18. Statutory Authority: RCW 74.13.031. WSR 01-08-047, § 388-25-0380, filed 3/30/01, effective 4/30/01.]