GAB Decision 459
Docket No. 83-129
August 3, 1983
Missouri Department of Social Services;
Ford, Cecilia; Teitz, Alexander Settle, Norval
In a July 5, 1983 Notice of Appeal, the Missouri Department of Social
Services (State) appealed the June 7, 1983 disallowance by the Health
Care Financing Administration (HCFA) of $445,729 in federal financial
participation claimed under Title XIX (Medicaid) of the Social Security
Act. The disallowance was based on a HCFA review of the State's
accounts receivable records for nursing homes. HCFA relied on the
records to determine that certain payments to nursing homes
participating in the Medicaid program were not allowable costs and
determined that the State should return the federal share of the
payments to HCFA regardless of when the State recovered the excess
payments from the nursing homes.
Along with its Notice of Appeal, the State made a motion that its
appeal be consolidated with other appeals, Docket Nos. 83-8 and 83-64,
before the Board. The State indicated that the same nursing homes were
involved in all the appeals, with the only difference being that the
disallowances involved were for different quarters.
The Board, however, decided the issues in Docket Nos. 83-8 and 83-64
in Decision No. 448, June 30, 1983. There the Board sustained HCFA's
disallowances in part, subject to a reduction for any amounts the State
could document have already been returned to HCFA. The Board also
directed HCFA to examine the effect of one court order which apparently
reversed the State's initial determination that overpayments occurred at
certain nursing homes. Delays in typing and mailing the decision
prevented the State from receiving its copy before it submitted the
present appeal.
In a july 28, 1983 telephone conversation with a Board staff
attorney, the attorney representing the State agreed that the amount
involved in this disallowance was not duplicative of the earlier
disallowance, and that this appeal should be governed by the reasoning
set forth in Decisioin No. 448. HCFA's counsel also agreed that
Decision No. 448 should be binding on this appeal.
Therefore, for the reasons set forth in Decision No. 448, we sustain
this disallowance. As in Decision No. 448, the (2) disallowance may be
reduced for amounts already repaid to HCFA. Also, as in Decision No.
448, CHFA should examine any court orders or final administrative
findings, submitted by the State, which may reverse any State
determination that overpayments occurred.
NOVEMBER 14, 1984