Quantcast
Home / Opinion Digests / Administrative / Administrative – Medicaid – Fraud Investigation – Payment Suspension – ‘Good Cause’ Determination – Constitutional – Due Process (access required)

Administrative – Medicaid – Fraud Investigation – Payment Suspension – ‘Good Cause’ Determination – Constitutional – Due Process (access required)

Team Daniel, LLC v. North Carolina Department of Health & Human Services, Division of Medical Assistance 42 C.F.R. § 455.21(a)(1) says Medicaid payments must be suspended during the investigation of a credible allegation of fraud unless good cause is found for not suspending payments or suspending them in part only. The chief of the Division of Medical Assistance Program Integrity Behavioral Health Section testified several times that his section made no effort to consider good cause prior to suspending payments to petitioner, and there is no evidence that anyone else gave any consideration to the regulation’s “good cause” exceptions prior to imposing the suspension.

Leave a Reply

Your email address will not be published. Required fields are marked *

*