Medicaid: CABINET FOR HEALTH AND FAMILY SERVICES V. EPI CORP. (COA; 4/14/2006)

CABINET FOR HEALTH AND FAMILY SERVICES V. EPI CORP.
GOVERNMENT –  Recouping Medicaid Payments by State
2005-CA-000274
PUBLISHED
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