Sufficiency of Evidence Medical Assistance Program Payments.

Byline: Derek Hawkins

WI Court of Appeals District IV

Case Name: Lee Quality Home Care LLC, v. Department of Health Services

Case No.: 2017AP1216

Officials: Sherman, Kloppenburg and Fitzpatrick, JJ.

Focus: Sufficiency of Evidence Medical Assistance Program Payments

This appeal concerns the efforts of the Wisconsin Department of Health Services (DHS) to recover payments DHS made to Lee Quality Home Care LLC, a provider of personal care services to Medicaid recipients. Lee Quality challenges DHS's determinations that: Lee Quality's personal care workers were not trained or supervised as required by DHS administrative rules; and DHS can recover payments made to Lee Quality for the services provided by those workers.

We conclude that there was substantial evidence in the record to support DHS's finding that Lee Quality personal care workers did not have the requisite training. We also conclude that DHS has the authority to recover payments made to Lee Quality for personal care services provided by those workers. As to the supervision of Lee Quality personal care workers, we conclude that DHS erred in finding...