DHS 108.02(9)(a)1.1. Offsetting or making an appropriate adjustment against other amounts owed the provider for covered services; DHS 108.02(9)(a)2.2. Offsetting or crediting against amounts determined to be owed the provider for subsequent services provided under the program if: DHS 108.02(9)(a)2.a.a. The amount owed the provider at the time of the department’s finding is insufficient to recover in whole the amount of the overpayment; and DHS 108.02(9)(a)2.b.b. The provider is claiming and receiving MA reimbursement in amounts sufficient to reasonably ensure full recovery of the overpayment within a reasonable period of time; or DHS 108.02(9)(a)3.3. Requiring the provider to pay directly to the department the amount of the overpayment. DHS 108.02(9)(b)(b) Written notice. No recovery by offset, adjustment or demand for payment may be made by the department under par. (a), except as provided under par. (c), unless the department gives the provider prior written notice of the department’s intention to recover the amount determined to have been overpaid. The notice shall set forth the amount of the intended recovery, identify the claim or claims in question or other basis for recovery, summarize the basis for the department’s finding that the provider has received amounts to which the provider is not entitled or in excess of that to which the provider is entitled, and inform the provider of a right to appeal the intended action under par. (e). Payment due the department shall be made by the provider within 30 days after the date of service of the notice of intent to recover. Final notices of intent to recover shall be sent by certified mail. DHS 108.02(9)(c)(c) Exception. The department need not provide prior written notice under par. (b) when the overpayment was made as a result of a computer processing or clerical error, for a recoupment of a manual partial payment, or when the provider requested or authorized the recovery to be made. In any of these cases the department or its fiscal agent shall provide written notice of any payment adjustments made on the next remittance issued the provider. This notice shall specify the amount of the adjustment made and the claim or claims which were the subject of the adjustments. DHS 108.02(9)(d)1.1. The department may suspend MA payments to a provider after the department determines there is a credible allegation of fraud for which an investigation is pending under the MA program against an individual or entity unless the department has good cause, as provided in subd. 6., to not suspend payments or to suspend payment only in part. A credible allegation of fraud is an allegation which has been verified by the department, from any source. Allegations are credible when they have indicia of reliability and the department has reviewed all allegations, facts, and evidence carefully. The department shall act judiciously on a case-by-case basis and will make referrals as appropriate. The department may withhold payments without first notifying the provider of its intention to withhold the payments. A provider is entitled to a hearing under s. DHS 106.12. DHS 108.02(9)(d)2.2. The department shall send written notice to the provider of the department’s suspension of MA program payments within 5 days after taking that action unless requested in writing by a law enforcement agency to temporarily withhold such notice. Law enforcement requests may last up to 30 days and may be renewed in writing up to twice and in no event may exceed 90 days. The notice shall state all of the following: DHS 108.02(9)(d)2.b.b. That the withholding action is for a temporary period, as defined under subd. 3., and cite the circumstances under which the suspension of payments will be terminated. DHS 108.02(9)(d)2.c.c. When appropriate, which type of MA claims or business units of a provider for which suspension is effective. DHS 108.02(9)(d)2.d.d. That the provider has a right to submit to the department written evidence regarding the allegations of fraud for consideration by the department. The provider shall be informed of this right. DHS 108.02(9)(d)3.3. Suspension of the provider’s payments shall be temporary. Suspension of payment may not continue after any of the following circumstances occurs: DHS 108.02(9)(d)3.a.a. The department or prosecuting authorities determine there is not sufficient evidence of fraud. DHS 108.02(9)(d)3.c.c. Legal proceedings relating to the provider’s alleged fraud are completed and charges against the provider have been dismissed. In the case of a conviction of a provider for criminal or civil forfeiture offenses, those proceedings shall not be regarded as being completed until all appeals are exhausted. In the case of an acquittal in or dismissal of criminal or civil forfeiture proceedings against a provider, the proceedings shall be regarded as complete at the time of dismissal or acquittal regardless of any opportunities for appeal which the prosecuting authority may have. DHS 108.02(9)(d)4.4. The department shall document in writing the termination of a suspension. DHS 108.02(9)(d)5.5. Whenever a department investigation leads to the initiation of a payment suspension in whole or part, the department shall make a fraud referral to the department of justice medicaid fraud control and elder abuse unit. The fraud referral shall be made in writing, conform to fraud referral performance standards, and be provided to the department of justice medicaid fraud control and elder abuse unit no later than the next business day after the suspension is enacted. If the department of justice medicaid fraud control and elder abuse unit accepts the fraud referral for investigation, the payment suspension may be continued until the investigation and any associated enforcement proceedings are completed. On a quarterly basis the department shall request certification from the department of justice medicaid fraud control and elder abuse unit that any matter accepted on the basis of a referral continues to be under investigation. If the department of justice medicaid fraud control and elder abuse unit declines to accept the fraud referral for investigation, the payment suspension shall be discontinued. DHS 108.02(9)(d)6.6. The department may find that good cause exists not to suspend payments or to not continue a previously imposed payment suspension if any of the following are applicable: DHS 108.02(9)(d)6.a.a. Law enforcement officials have requested that a payment suspension not be imposed because such a payment suspension may compromise or jeopardize an investigation. DHS 108.02(9)(d)6.b.b. Other available remedies implemented by the department more effectively or quickly protect MA funds. DHS 108.02(9)(d)6.c.c. The department determines, based upon the submission of written evidence by the provider, that the suspension should be removed. DHS 108.02(9)(d)6.d.d. Beneficiary access to items or services would be jeopardized by a payment suspension if the provider is the sole community physician or the sole source of essential specialized services in a community or the provider serves a large number of beneficiaries within a health resources and services administration-designated medically underserved area. DHS 108.02(9)(d)6.e.e. Law enforcement declines to certify that a matter continues to be under investigation. DHS 108.02(9)(d)6.f.f. The department determines that payment suspension is not in the best interests of the MA program. DHS 108.02(9)(d)7.7. The department may find that good cause exists to suspend payments in part, or to convert a previously imposed payment suspension in whole to one only in part, to a provider against which there is an investigation of a credible allegation of fraud if any of the following are applicable: DHS 108.02(9)(d)7.a.a. Beneficiary access to items or services would be jeopardized by a payment suspension in whole or part because provider is the sole community physician or the sole source of essential specialized services in a community, or the provider serves a large number of beneficiaries within a health resources and services administration-designated medically underserved area. DHS 108.02(9)(d)7.b.b. The department determines, based upon the submission of written evidence by the provider, that the suspension should be imposed only in part.