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Judge: Agency overreached in asking nurses to repay Medicaid

MADISON, Wis. (AP) — A judge has ruled that Wisconsin health officials went too far trying to recoup Medicaid payments from dozens of independent nurses who care for severely disabled patients in their homes.

Waukesha County Circuit Court Judge Kathryn Foster made her ruling in late September. She found the Wisconsin Department of Health Services exceeded its authority when it asked the nurses to return Medicaid payments for not fully complying with rules in documenting the care they provided, the Wisconsin State Journal reported.

Nurses say state auditors became aggressive starting in 2012, asking them to pay back $7,000 to $142,000 or more each because of paperwork mistakes, such as not providing proof that doctors had ordered vitamin D or Tylenol. The cases do not involve alleged fraud.

The state maintains auditors conducted proper reviews of the independent nurses, who bill Medicaid directly for their services. The state has until Nov. 11 to appeal the ruling.

Heidi Unke is a nurse from Waterford who cared for a paralyzed man in his home until 2013, when the state said she had to return $58,000.

“I will never do this work again,” Unke said. She said the $58,000 repayment request stemmed from a misplaced decimal point in recording the dosage of a drug for which the correct dosage was given, and for not specifying that her patient wore shoes to protect his feet, as he did.

The state’s demand for repayment prompted Unke to get a job at a hospital. Her recoupment case is pending.

Health Services Department spokeswoman Elizabeth Goodsitt said the department’s Office of the Inspector General was created five years ago to improve fraud prevention and “public assistance program integrity.”

“Documentation of medical care is a vital part of patient care and patient safety,” Goodsitt said.

Nearly 2,000 independent nurses in Wisconsin provide in-home care through Medicaid for patients with complex needs, many of whom are on ventilators, according to Kathleen Papa, a board member of Wisconsin Professional Homecare Providers, which represents about 350 of the nurses. It is unclear how many of the nurses were subject to questionable recoupments.

Many independent nurses left their practices because of the state’s demands to give back money they earned, causing hardship for families who depend on the nurses, Papa said. She said she hopes the ruling will encourage some of the nurses to return.

“I think it will give them some security,” Papa said. “They should be able to retain their money for services provided and not work in fear that the state will audit them and take back every penny for something minor.”


One comment

  1. personal experience with K. W. Foster point to judicial misconduct–she openly testifies for respondents in open court . . . any other opinion would be suspect, as well

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