CABINET FOR HEALTH AND FAMILY SERVICES V. EPI CORP.
GOVERNMENT – Recouping Medicaid Payments by State
AFFIRMING IN PART, REVERSING AND REMANDING IN PART (BARBER)
DATE: Apr. 14, 2006
The primary issue in this current appeal is recoupment by the Cabinet for alleged overpayments of Medicaid benefits to EPI’s long-term care facilities. There is a long history of disagreement between the parties spanning nearly three decades
Each year, facilities participating in the Medicaid program are required to submit cost reports to the Cabinet in a timely manner per the Cabinet’s regulations. The time period for recoupment shall not exceed twelve (12) months from the date the overpayment is established, and shall be accomplished within twenty-one (21) months from the end of the provider’s cost reporting period . . . (Emphasis added.) 907 KAR 1:110(1988-1995). The record reflects that the Cabinet did not recoup any funds for cost years 1988 through 1995 within twenty-one months from the end of the provider’s cost reporting period. Therefore, it is now barred from recouping said funds in accordance with its own regulation.
Digested by Michael Stevens