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.
Professional Homecare Providers garnered another key victory in Waukesha County Court on February 14, following up on that court's ruling last September that the Department of Health Services may only recoup past payments to Medicaid providers 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 the Professional Homecare Providers' motion, brought by Attorney Diane Welsh, the court determined that the Department has failed to comply with the September order, violating its order and the injunction it imposed by continuing to pursue recoupments against individual nurses for prohibited reasons. As a result, the court issued a warning to the Department and ordered it to pay the providers' fees and costs for bringing the motion. Attorneys Susan Crawford and Aaron Dumas assisted in obtaining the supplemental relief sought by the Plaintiffs.
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).