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Petitioner, a personal care home, appealed the decision of the Department of Community Health to recoup a year of payments for services to a Medicaid recipient.  The Department’s decision was based upon Petitioner’s failure to adhere to the recipient’s individual service plan (“ISP”).  Judge Baxter reversed the recoupment decision, finding that Petitioner provided all of […]

Petitioner, a hospital, appeals Respondent’s decision to deny its claim for Medicaid coverage of an inpatient medical procedure it performed on a patient in its facility. The patient had originally been scheduled for an outpatient procedure and the procedure had been coded as such. Petitioner failed to request an update in the precertification code within