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Medicaid Reimbursement Calculation

Topic: Health Law, Decided by Judge Barnes 
Docket Number: 1926998 , Decision Date: 2019-12-22 
Attachment: Click here to download the decision. 

Where five nursing facilities reduced their licensed bed capacities, creating semi-private rooms and increasing the square footage per bed, the agency was directed to recalculate the property component of the Medicaid reimbursement rates.

Private Home Care Provider Licensing

Topic: Health Law, Decided by Judge Schroer 
Docket Number: 2012779 , Decision Date: 2020-02-12 
Attachment: Click here to download the decision. 

After a DCH inspector twice failed to gain entry to the office of the private home care provider for unannounced inspections, DCH revoked the Petitioner’s license.  The decision to revoke the license was reversed and remanded; instead, the appropriate sanction was suspension of the license [..] Read More..

Evidence insufficient to show “alter ego”

Topic: Health Law, Decided by Judge Schroer 
Docket Number: 1847952 , Decision Date: 2018-10-04 
Attachment: Click here to download the decision. 

Text messages and statement in lease regarding payment of security deposit insufficient to show “alter ego.”

Maximum civil penalty not authorized

Topic: Health Law, Decided by Judge Brown 
Docket Number: 1834337 , Decision Date: 2018-08-28 
Attachment: Click here to download the decision. 

DCH was not authorized to impose the maximum civil penalty against a personal care home where it did not show that the deficiencies placed hospice patient at risk of harm, discomfort, or death.

Durable power of attorney for healthcare is not equivalent to advance directive

Topic: Health Law, Decided by Judge Brown 
Docket Number: 1707847 , Decision Date: 2016-12-13 
Attachment: Click here to download the decision. 

Staff members of a personal care home (PCH) did not perform CPR on a resident upon discovering him unconscious.  The owner of the PCH argued that its staff members were not obligated to perform CPR because the resident had a durable power of attorney for [..] Read More..

Transfer penalty must be applied month of asset transfer or date of Medicaid eligibility

Topic: Health Law, Decided by Judge Teate 
Docket Number: ******* , Decision Date: 2016-12-16 
Attachment: Click here to download the decision. 

After she received a $41,000 lump-sum settlement in a lawsuit, a nursing home resident made a gift of $23,724.  She simultaneously loaned $16,000 to her daughter, who executed a promissory note obligating her to repay the sum in monthly installments for the resident’s nursing home [..] Read More..

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