OK SB1645

Oklahoma Health Care Authority and contracted entities must provide Medicaid providers at least 1 week notice before initiating audits and may only audit a provider twice per calendar year (except for specifically identified problems)

Audits are limited to 50 claims or 0.25% of claims billed in the previous year, cannot exceed a 24-month lookback period, and cannot use statistical sampling or extrapolation to calculate overpayments

Clerical or recordkeeping errors (typos, scrivener's errors, computer errors) cannot constitute fraud or trigger criminal penalties without proof of intent, though they may still be subject to recoupment

Providers have at least 60 days to file corrected claims after overpayment notice, 60 days to produce documentation after preliminary audit reports, and recoupment of disputed funds can only occur after final disposition including appeals

Appeals process allows providers to challenge final audit reports to the Authority, then to a designated administrative law judge, and finally to district court within 30 days; the bill takes effect January 1, 2027