The Wisconsin Department of Health Services (DHS) demanded hundreds of thousands of dollars back from Medicaid providers for minor clerical errors elaborated in detailed, prescriptive documentation requirements. But DHS never promulgated a rule saying it could recoup wages for those violations, leaving the providers without proper notice or a chance to weigh in on policies that threatened their livelihoods.
As GLLF explained in its amicus brief:
“This case involves one topic found in one guidance document—the Medicaid Provider’s Handbook—known as Topic #66. This “guidance” provision states that the service provided by Medicaid providers, such as the Nurses, “must meet all applicable program requirements, including, but not limited to [specified requirements].” Emphasis added. Topic #66 is vacuous. It means nothing because it means everything. It provides no helpful information for Medicaid providers on DHS’s recoupment policies.
“If providers do not meet this open-ended, undefined directive, they are subject to recoupment actions that include all the compensation received for services provided to patients for days, weeks, months, or even years. Nurses were not given fair notice to what “all applicable requirements” meant. Only after DHS initiated Medicaid payment claw-back proceedings were they given the specifics of their offenses. Generally, DHS alleged paperwork discrepancies. But the Nurses provided the homecare services otherwise covered by Medicaid. It remains unclear what authority DHS has to recoup so much money for so much work based upon mostly technical violations. “
Read the rest of GLLF’s brief here.