No recoupment of funds where Department coordinator failed to amend ISP.
Docket Number: 1328859 , Decision Date: May 3, 2013
Attachment: Click here to download the decision.
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 the services that the Department was willing to fund. The Department could not penalize Petitioner where the failure to amend the ISP was due to a Department contractor’s error.