Hospice’s lack of due diligence on waiver status led to Medicaid overpayment

Topic: Health Law, Decided by: Judge Woodard 
Docket Number: 2326197 , Decision Date: September 21, 2023 
Attachment: Click here to download the decision. 

The Department of Community Health (DCH) alleged an overpayment of $102,168.98 to a hospice that submitted Medicaid claims for two patients who already had concurrent claims with Medicaid waiver services. The Court affirmed the recoupment in part and reversed it in part.  The Court found that the facility reasonably relied on the State’s own information system to determine the waiver status of one patient; but the hospice failed to do proper due diligence on the other patient’s status.

Upheld on agency review.

Update as of 5/16/2024: Judicial review remains pending before the Superior Court of Fulton County, Case No. 2023CV390098.

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