Lisa Boggs

Reimbursement denied where provider failed to document that inpatient services met program criteria.

Crisp Regional Hospital, a Medicaid-enrolled provider, did not document the medical necessity of services provided to a patient in its care.  Specifically, the hospital did not write on “utilization review notes” that the patient met “severity of illness or intensity of service” criteria for the dates of hospitalization.  Accordingly, it did not meet Georgia Medicaid […]

Reimbursement denied where provider failed to document that inpatient services met program criteria. Read More

State may recoup reimbursements for child care services that were unsupported by facility’s records.

Inspiration Station Academy (“the Center”), a daycare, received subsidies from the Department of Early Care and Learning (DECAL) through the Childcare and Parent Services (CAPS) Program.   Pursuant to an agreement with DECAL, the Center was required to keep attendance records for each child for whom it obtained reimbursement.  DECAL was authorized to recover payments to

State may recoup reimbursements for child care services that were unsupported by facility’s records. Read More

Due Process Complaint dismissed for failure to include a proposed resolution.

Petitioner’s Due Process Complaint against a school system was dismissed without prejudice because Petitioner failed to adhere to the Individuals with Disabilities Education Act (IDEA) requirement that such complaints include “a proposed resolution of the problem to the extent known and available to the complaining party.”

Due Process Complaint dismissed for failure to include a proposed resolution. Read More

Applicant’s academic and career achievements support grant of appraiser classification.

Petitioner applied for appraiser classification approximately twelve years after his appraiser classification was revoked for failure to comply with a Consent Order.  The Georgia Real Estate Appraiser Board denied the application based upon the revocation as well as Petitioner’s conviction for misdemeanor theft in 1992, which he failed to disclose on prior applications.  The denial

Applicant’s academic and career achievements support grant of appraiser classification. Read More

Inclusion of Income of student’s parents resulted in reduction, not termination, of benefits.

The Georgia Vocational Rehabilitation Agency (GVRA) sought to discontinue college tuition payments that Petitioner received through the Vocational Rehabilitation program after program requirements were changed to include the income of recipients’ parents in the calculation of benefit amounts.  While GVRA was entitled to reduce tuition payments pursuant to the updated policy, inclusion of Petitioner’s parents’

Inclusion of Income of student’s parents resulted in reduction, not termination, of benefits. Read More

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