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Posts tagged "Perfection Standard"

Waukesha County Court Protects Health Care Providers' Medicaid Payments from Unfair Government Recoupment Efforts

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).

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