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Welsh Scores a Victory for Medicaid Providers

This week, the Wisconsin Court of Appeals held that the Department of Health Services was not entitled to recoup Medicaid payments made to a family planning clinic based on certain recordkeeping disputes. The Court found that the clinic was not required to keep records the Department asserted were required, and that an omission on the claims form did not provide the Department with legal authority to recoup payments which it had already made.

The Court of Appeals upheld a decision of the Oconto County Circuit Court, which had also found the Department exceeded its authority in its attempt to recoup under the circumstances. That decision reversed an administrative decision that would have permitted the Department's Office of the Inspector General to recoup over $180,000 in Medicaid payments for prescription drugs that were indisputably provided to Medicaid enrollees by the clinic.

Pines Bach partner Diane Welsh represented the clinic at all phases of the case; Christa Westerberg assisted on the appeal. The Opinion, available here is recommended for publication.

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