June 2016

Posted on July 1st, 2016 by admin

The Kay Law Firm successfully reduced a $348,427 Medicaid penalty to $40,533 through the appeals process.   After full hearing and briefing by Marisol Perez, the Administrative Law Judge determined that $278,868.47 of money at issue held in a joint account belonged solely to the son and not the nursing home resident.  The Director was unable to dispute the correctness of the Administrative Law Judge’s finding and upheld the determination.  Unfortunately, although the Administrative Law Judge also found that the remaining $69,559 was improperly subject to a penalty, the Director remanded the case back to the County for further fact finding on how those funds were used during the look back period.  Upon remand, Marisol Perez demonstrated sufficient proofs such that the County further reduced the penalty by $29,026 and the parties thereafter settled the matter to minimize additional legal expenses and allow the facility to begin receiving payment from Medicaid.