| (a) The OAG may verify and investigate an application
or award. Verification and investigation includes, but is not limited
to:
(1) a verification of any evidence submitted to the
OAG;
(2) a review of records submitted by a service provider;
or
(3) a post payment audit to verify actual charges,
bills, payments, and the delivery of goods or services.
(b) The OAG may require additional supporting documentation
from a victim, claimant, or service provider.
(c) If the OAG determines that the supporting documentation
is insufficient to process a payment, the OAG may deny payment.
(d) If the OAG determines that charges or bills submitted
by a service provider are not in compliance with the laws and regulations
governing a profession or industry, the OAG may notify the appropriate
licensing or regulatory agency governing the service provider.
(e) A service provider is subject to a reduction or
denial of payment, a request for a refund of any overpayments as described
in §61.305 of this chapter (relating to Overpayments to Service
Providers), and any other penalties authorized by law, for the following
acts:
(1) submitting charges for services that were not rendered;
(2) submitting charges that are not reasonable and
necessary;
(3) violating rules and regulation set forth by a state
or federal licensing or regulatory agency; or
(4) failing to submit the required documentation for
services rendered and payments received.
(f) In order to verify the reasonableness and necessity
of certain pecuniary losses, a victim or claimant may be required
to submit to an independent medical evaluation by an M.D. or a D.O.
The evaluation will be scheduled and paid for by the OAG. In addition,
a health care service provider who treats the victim or claimant may
also be required to submit a current treatment recommendation.
(g) In order to receive or continue receiving compensation
for personal injury that is or has been exacerbated by the criminally
injurious conduct, a victim or claimant may be required to submit
to an independent medical evaluation by an M.D. or D.O. The evaluation
will be scheduled and paid for by the OAG. In addition, a health care
service provider who treats the victim or claimant may also be required
to submit medical documentation relating to the personal injury prior
to and after the date of crime.
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