Attorney Diane Welsh recently won a series of important rulings for Medicaid providers. The Wisconsin State Journal recognized the significance of the Waukesha County Circuit Court's findings by publishing an article about the matter in its Sunday edition. The story by David Wahlberg can be read on the newspaper's main site, or by clicking here.
On September 27, 2016, the Waukesha County Circuit Court ruled that the Wisconsin Department of Health Services may lawfully recoup past payments to Medicaid providers only if the Department cannot verify that the services were provided or if the Department determines that the amount paid was inaccurate or inappropriate for the services.
On August 12, 2016, the Waukesha County Circuit Court ruled that the Wisconsin Department of Health Services ("DHS") exceeds its authority when it applies a perfection standard, then uses that standard as a basis for recouping Medicaid payments that were made for necessary services provided to Medicaid enrollees. The Court declared that DHS's authority under Wis. Stat. § 49.45(3)(f) is limited to circumstances where either: 1) DHS is unable to verify from the provider's records that services were actually provided; or 2) the payment was inaccurate or inappropriate for the service provided (such as a mathematical error or duplicative charge).