Sufficiency of Evidence – Medical Assistance Program Payments

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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 that Lee Quality made a material concession about the evidence, and that DHS did not consider material evidence regarding that issue. As we explain, we direct the circuit court to remand this matter to DHS for a determination of the supervision issue in light of relevant evidence in the record. Therefore, we affirm in part, reverse in part and direct the circuit court to remand to DHS for further proceedings consistent with this opinion.

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Derek A Hawkins is trademark corporate counsel for Harley-Davidson. Hawkins oversees the prosecution and maintenance of the Harley-Davidson’s international trademark portfolio in emerging markets.