DCH may recoup reimbursements paid to provider due to agency error.
Docket Number: 1732250 , Decision Date: June 26, 2017
Attachment: Click here to download the decision.
Mobile Med, Inc. sought and obtained reimbursement for supplying Medicaid members with two ventilators each—one primary, and one “back-up” ventilator—over the course of two years, despite a provision in the Department of Community Health’s (DCH) provider manual that allowed for reimbursement for only one ventilator per member. DCH was authorized to recoup the overpayment even though it was attributable to its own error because its policy manual prohibited such reimbursement and Mobile Med became bound by the terms of the manual when it enrolled as a Medicaid provider.